NCLEX study
A client has obtained levonorgestrel as emergency contraception. After unprotected sex the client calls the clinic to ask a question about taking the contraceptives. the nurse realizes the client needs further explanation when she makes which statement? 1.) "I can wait up to 4 days after intercourse to start taking these to prevent pregnancy." 2.) "My boyfriend can buy levonorgestrel from the pharmacy if he is over 18 years old" 3.)"The birth control works by preventing ovulation or fertilization of the egg." 4.)"I may feel nauseated and have breast tenderness or a headache after using the contraceptive."
(1) Levonorgestrel can reduce the chance of pregnancy if taken within 72 hours of unprotected sex and then again 12 hours later waiting 4 days to take levonorgestrel reduces effectiveness males can purchase with contraceptive as long as they are over 18 years of age levonorgestrel works by preventing ovulation or fertilization depending on where a client is in the menstrual cycle common side effects include nausea, breast tenderness, vertigo, and stomach pain
A couple is inquiring about vasectomy as a permanent method of contraception. which teaching statement would the nurse include in the teaching plan? 1.) "another method of contraception is needed until the sperm count is zero" 2.) "vasectomy is easily reversed if children are desired in the future" 3.) "vasectomy is contraindicated in males with prior history of cardiac disease" 4.)"Vasectomy requires only a yearly follow-up once the procedure is completed"
(1) another method of contraception is needed until all sperm has been cleared from the body. the number of ejaculates for this to occur varies with the individual, and laboratory analysis is required to determine when that has been accomplished. vasectomy is considered a permanent sterilization procedure and requires microsurgery for anastomosis of the vas deferens to be completed. studies have shown that there is no connection between cardia disease in males and vasectomy. there is no need for follow-up after verification there is no sperm in the system.
A 19 year old nulligravid client visiting the clinic for a routine exam asks the nurse about cervical mucus changes that occur during the menstrual cycle, which info would the nurse expect to include in the client's treatment plan? 1.) about midway through the menstrual cycle, cervical mucus is thick and sticky 2.)during ovulation, the cervix remains dry without and mucus production 3.)as ovulation approaches, cervical mucus is abundant and clear 4.) cervical mucus disappears immediately after ovulation, resuming with menses
(3) as ovulation approaches, cervical mucus is abundant and clear, resembling raw egg white. ovulation generally occurs 14 days before the beginning of menses. during the luteal phase of the cycles, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. changes in the cervical mucus are related to the influence of estrogen and progesterone. cervical mucus is always present.)
An antenatal G2, T1, P0, A0, L1 client is discussing her postpartum plans for birth control with her health care provider. In analyzing the available choices, which factor has the greatest impact on her birth control options? a) breast- or bottle-feeding plan b) desire for another child in 2 years c) satisfaction with prior methods d) preference of sexual partner
(1) birth control plans are influenced primarily by whether the mother is breast- or bottle-feeding her infant. the maternal milk supply must be well established prior to the initiation of most hormonal birth control methods. low-dose oral contraceptives would be the exceptions. use of estrogen-progesterone- based pills and progesterone onl pills are commonly initiated from 4 to 6 weeks postpartum because the milk supply is well established by this time. prior experiences with birth control methods have an impact on the method chosen as do the preferences of the client's partner, however, they are not the most influential factors. desire to have another child in 2 years would make some methods such as an IUD, less attractive but would still be secondary to the choice to breastfeed
Which instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate? 1.) take a mild analgesic if needed for menstrual pain 2.) avoid cold foods if menstrual pain persists 3.) stop exercise while menstruating 4.)Avoid tampons until you have had your periods for 1 year
(1) the nurse should instruct the client to take a mild analgesic such as ibuprofen, if menstrual pain, or cramps are present. the client should also eat foods rich in iron and should continue moderate exercises during menstruation, which increases abdominal tone. avoiding cold foods will not decrease dysmenorrhea. use of pads or tampons is a personal choice. there is no evidence that it is necessary to wait to use tampons
when instructing a client about the proper use of a condom for pregnancy prevention, the nurse should include which instruction to ensure maximum effectiveness? 1.)place the condom over the erect penis before coitus 2.) withdraw the condo after coitus when the penis is flaccid 3.)ensure that the condom is pulled tightly over the tip of the penis before coitus 4.) obtain a prescription for a condom with nonoxynol 9
(1) to ensure maximum effectiveness, the condom should be placed over the erect penis before coitus. some couples find condom use objectionable because foreplay may have to be interrupted to apply the condom. the penis covered by the condom should be withdrawn before the penis becomes flaccid. otherwise semen may escape from the condom, providing and opportunity for possible fertilization. rather than having the condom pulled tightly over the penis before coitus, space should be left at the tip to allow the condom to hold the sperm. the client does not need a prescription for a condom with nonoxynol 9 because these are solve over the counter
A 39 year old multigravid client asks the nurse for info about female sterilization with a tubal ligation. which client statement indicates effective teaching? 1.) "My fallopian tubes will be tied off through a small abdominal incision" 2.) "Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%" 3.) After this procedure, I must abstain from intercourse for at least 3 weeks" 4.) Both of my ovaries will be removed during the tubal ligation procedure"
(1) tubal ligation, a female sterilization procedure, involves ligation (tying off) or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30 %. after tubal ligation the client may engage in intercourse 2 to 3 days after the procedure. the ovaries are not generally removed during the ligation. an oophorectomy involves removal of one or both ovaries.
After conducting a class for female adolescents about human reproduction the nurse concludes teaching has been effective when a student makes which statement? 1.) "under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy" 2.) "I will not become pregnant if I abstain from sex during the last 14 days of my menstrual cycle" 3.) "Sperms from a healthy male usually remain viable in the female reproductive tract for 96 hours" 4.) "After an ovum is fertilized by a sperm the ovum contains 21 pairs of chromosomes"
(1) under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. this is an important point to make with adolescents who may be sexually active. many people believe that the time interval is much longer and that they can wait until after intercourse to take steps to prevent conception. without protection, pregnancy and STD's can occur. when using the abstinence or calendar method, the couple should abstain from intercourse on the days of the menstrual cycles when the woman is most likely to conceive. using a 28 day cycles as an example a couple should abstain from coitus 3 to 4 days after ovulation (days 10 through 14) and 3 to 4 days after ovulation (days 15 through 18). sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. if the female client ovulates after coitus, there is a possibility that fertilization can occur. before fertilization the ovum and sperm each contain 23 chromosomes. after fertilization the conceptus contains 46 chromosomes unless there is an abnormality
Before advising a twenty-four year old client desiring oral contraceptives for family planning, the nurse would assess the client for which signs and symptoms? 1.)anemia 2.) hypertension 3.) dysmenorrhea 4.) acne vulgaris
(2) before advising a client about oral contraceptives the nurse needs to assess the client for signs and symptoms of hypertension. clients who have hypertension, thrombophlebitis, obesity, or family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. in addition, women who smoke, are older than 40 years, or have history of pulmonary disease should be advised to use a different method. iron deficiency indicates for the use of oral contraceptives. iron deficiency anemia is common among young women. oral contraceptives decrease the amount of iron lost through menses, thereby benefiting the patient. low- dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycles. the use of oral contraceptives have shown to improve facial acne.
A 23 year old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning, what instructions should the nurse give the client? 1.) check the cervical mucus to see if it is thick and sparse 2.) take her temperature at the same time every morning before getting out of bed 3.)Document ovulation when her temperature decreases at least 1'F (0.56"C) 4.) Avoid coitus for 10 days after a slight rise in temperature
(2) the basal body temp method requires that the client taker her temp each morning before getting out of bed, preferably at the same times each day before eating or any other activities. just before the day of ovulation the temp falls by 0.5'F, at the time of ovulation the temp rises 0.4'F to 0.8'F because of increased progesterone secretion in response to the luteinizing hormone. the temp remains higher for the rest of the menstrual cycle. the client should keep a diary of about 6 months of menstrual cycles to calculate "safe" days. there is no mucus for the first 3 to 4 days after menses, and then thick, sticky mucus begins to appear. as estrogen increases, the mucus changes to clear, slippery, and stretchy. this condition, termed spinnbarkeit, is present during ovulation. after ovulations, the mucus decreases in amount and becomes thick and sticky again until menses. because the ovum typically survives about 24 hours and sperm can survive up to 72 hours, couples must avoid copious and for about 3 to 4 days before and after ovulation to avoid pregnancy.
A twenty year old nulligravid client expresses a desire to learn more about the symptothermal method of family planning. which info would the nurse include in the teaching plan? 1.) This method has a fifty percent failure rate during the first year of use 2.) couples must abstain from coitus for five days after the menses 3.) cervical mucus is carefully monitored for changes 4) the male partner uses condoms for significant effectiveness
(2) the symptothermal method is a natural method of fertility management that depends on the knowing when ovulation has occurred. because regular menstrual cycles can vary by 1 to 2 days in either direction, the symptothermal method requires daily basal body temp assessments plus close monitoring of the cervical mucus changes. the method relies on abstinence during the period of ovulations, which occurs approx. 14 days before the beginning of the next cycle. abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation will occur during this time period (days 1 through 10). typ9ically the failure rate for this method is between 10%-20%. although a condom may increase the effectiveness of this method, most clients who choose natural methods are not interested in chemical or barrier types of family planning
which info would the nurse include in the teach plan for a thirty-two year old female client requesting info about using a diaphragm for family planning? 1.) douching with an acidic solution after sex is recommended 2.) diaphragms should not be used if the client develops acute cervicitis 3.) the diaphragm should be washed in a weak solution of bleach and water 4.) the diaphragm should be left in place for 2 hours after sex
(2) the teach plan should include a caution that a diaphragm should not be used if the client develops acute cervicitis, possible aggravated by contact with rubber of diaphragm. some studies have also associated diaphragm and intercourse is not recommended because pregnancy could occur. the diaphragm should be inspected and washed with mild soap and water after each use. a diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. more spermicidal jelly or cream should be used if intercourse is repeated during this period.
which info would the nurse include in a teaching plan about treatments for sexually transmitted infections? 1.)acyclovir can be use to cure herpes genitalis 2.)chlamydia trachomatis infections are usually treated with penicillin 3.)ceftriaxone may be use to treat neisseria gonorrhoeae inections 4.)metronidazole is used to treat condylomata acuminatauire
(3) ceftriaxone may be used to treat n. gonorrhoeae infections, and is commonly combined with doxycycline. both the client and her partner should be treated if STD is present. acyclovir can be used to treat herpes but it will not cure it. C. trachomatis (chlamydia) infections are usually treated with antibiotics such as doxycycline or azithromycin. metronidazole is used to treat trichomoniasis vaginitis, not condylomata acuminata (genital warts)
Which information would be important to include in the teaching plan for the client who wants more info on ovulation and fertility management? 1.) the ovum survives for 96 hours after ovulation, making conception possible during this time 2.) the basal body temp falls at least 0.2 'F (0.17 'C) after ovulation has occurred 3.) ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle 4.)Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus
(3) for a client with a typical menstrual cycle for 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. ovulation does not usually occur during the menses component of the cycle when the uterine lining is being shed. in most women, the ovum survives for about 12 to 24 hours after ovulation, during which time conception is possible. the basal body temp rises 0.5'F to 1.0'F when ovulation occurs. although some women experience some pelvic discomfort during ovulation (mittelschmerz), severe or unusual pain is rare. after ovulation the cervical mucus is thin and copius.
The nurse teaches a client about using medroxyprogesterone as a birth control method. which client statement indications effective teaching? 1.) "this method of family planning requires monthly injections" 2.) "I should have my first injection during my menstrual cycle" 3.)"one possible adverse effect is absence of a menstrual period" 4.)"this drug will be given by subcutaneous injections"
(3?) with medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common adverse effects. other adverse effects include weight gain, breakthrough bleeding, headaches, and depression. this method requires deep intramuscular injections q 3 months. the first injection should occur within 5 days after menses
A couple visiting the fertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical exam of both partners, what would be the most appropriate outcome for the couple to accomplish by the end of the visit? 1.)choose an appropriate infertility treatment method 2.) acknowledge that only 50% of infertile couples achieve a pregnancy 3.) discuss alternative methods of having a family such as adoption 4.) describe each of the potential causes and possible treatment modalities
(4) by the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. if their evaluation shows that a treatment or procedure may help them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. treatments can be difficult, pain, and risky. the first visit is not the appropriate time to decide on a treatment plan because the couple needs to time to adjust to the diagnosis of infertility, a crisis for most couples. although the couple may be in a hurry for definitive therapy, a thorough assessment of both partners is necessary before a treatment plan can be initiated. the success rate for achieving a pregnancy depends on both the cause and the effectiveness of the treatment , and in some cases, it may be only as high as 30%. the couple may desire info about alternative to treatment but insufficient data are available to suggest that a specific treatment modality may not be successful. suggesting that the couple consider adoption at this time may inappropriately imply that the couple has no other choice. if a specific therapy my result in pregnancy, the couple should have time to consider their options. after a thorough evaluation, adoptions may be considered by the couple as an alternative to the costly, time-consuming and sometimes painful treatments for infertility
a 20 year old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth, which response would be the most helpful? 1.) "today's modern technology has resulted in a low maternal mortality rate" 2.)"do not concern yourself with things that happened in the past" 3.) "in north america mothers seldom die in birth" 4.)"what is it that concerns you about pregnancy, labor, or birth?"
(4) the client is verbalizing concerns about death during birth, thus providing the nurse with an opportunity to gather additional data. asking the client about these concerns would be most helpful to determine the client's knowledge base and to provide the nurse with the opportunity to answer any questions and clarify any misconceptions. although the maternal mortality rate is low in the US and Canada, maternal death to occur, even with modern technology. leading causes of maternal mortality in the US and Canada include embolism, pregnancy-induced hypertension, hemorrhage, ectopic pregnancy, and infection. telling the client not to concern herself about what has happened in the past is not useful. it only serves to discount the client's concerns and block further therapeutic communication. also, postponing or ignoring the client's need for a discussion about complications of pregnancy may further increase the client's anxiety
after being examined and fitted for a diaphragm, a twenty-four year old client receives instructions about its use. which client statement indications a need for further teaching? 1.) "I can continue to use the diaphragm for about two to three years if I keep it protected in the case" 2.) "If I get pregnant I will have to be refitted for another diaphragm after birth" 3.) "before inserting the diaphragm, I should coat the rim with contraceptive jelly" 4.) "if I gain or lose 20 lbs (9kg), I can still use the same diaphragm"
(4) the client would need additional instructions when she says that she can still use the same diaphragm if she gains 20lbs. gaining or losing more than 15lbs can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. the diaphragm can be used to 2 to 3 years if it is cared for and well protected in its case. the client should be refitted for another diaphragm after pregnancy and birth because weight changes and physiological changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. the client should use a spermicidal jelly or cream before inserting diaphragm.
After instructing a twenty-year old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect? 1.) weight gain 2.) nausea 3.) headache 4.) ovarian cancer
(4) the nurse determines that the client needs further instruction when the client says that one adverse effect of oral contraceptive use is ovarian cancer. some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding and monilial infections. the most serious adverse effect is thrombophlebitis
which instructions should the nurse include in the teaching plan for 30 year old multiparous client who will be using an intrauterine device (IUD) for family planning? 1.)amenorrhea is a common adverse effect of IUD's 2.) additional conception protection will be needed 3.)IUD's are more costly than other forms of contraception 4.) severe cramping may occur when the IUD is inserted
(4)) severe cramping and pain may occur as the device is passed through the internal cervical os. the insertion of the device is generally done when the client is having her menses because it is unlikely that she is pregnant at that tie. common adverse effects of IUD's are heavy menstrual bleeding and subsequent anemia, not amenorrhea. uterine infections or ectopic pregnancy may occur. the IUD has an effectiveness rate of 98%. therefore, additional protection is not necessary to prevent pregnancy. IUD's generally are less costly than other forms of contraception because they do not require additional expense. only one insertion is necessary, in comparison to daily doses of oral contraceptives or the need for spermicides in conjunction with diaphragm use
