Pharm 1(Cpt. 62)

A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works?

"I will need to use backup contraception if I miss a pill." When a patient taking a progestin-only OC misses one or more pills, backup contraception should always be used for at least 2 days. Irregular bleeding occurs but is not an indication to stop using the drug, although many women do because of the inconvenience.

A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?

An 18-year-old woman with multiple sexual partners Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs

A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what?

Change products at the beginning of her next cycle. When changing one combination OC for another, the change is best made at the beginning of a new cycle. It is not correct to begin taking the new product immediately; to stop the old product 1 week before starting the new product; or to use an alternate method of birth control between regimens.

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider?

DMPA (Depo-Provera) and condoms This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs

A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do?

Discuss an oral contraceptive with increased estrogen. Carbamazepine induces hepatic cytochrome P450 and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced OC blood levels; patients experiencing this symptom may need an increased estrogen dose.

A patient asks about the effectiveness of various birth control methods. The nurse should inform her that the most effective methods are what? (Select all that apply.)

Intrauterine devices (IUDs) Intramuscular medroxyprogesterone acetate Etonogestrel subdermal implants Male or female sterilization The most effective methods of birth control are IUDs, intramuscular medroxyprogesterone acetate [Depo-Provera], implants, and sterilization. Spermicides are not one of the most effective methods of birth control.

A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do?

Schedule an appointment for her to receive the injection in 3 weeks. To ensure that patients are not pregnant when they receive DMPA, the first injection should be given during the first 5 days of a normal menstrual period.

A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest?

She should discard the inert pills and start a new pack during the honeymoon. OC users can achieve an extended-cycle schedule by discarding the inert pills and beginning a new pack for up to four cycles. It is not necessary to discontinue OCs.

A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient?

The patient should discuss an alternate method of birth control prior to surgery. Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider

A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend?

The patient should request an OC containing less estrogen. Breast tenderness, edema, and nausea are associated with estrogen; women experiencing these side effects may benefit from an OC with a lower estrogen dose. Lowering the progestin will not decrease these symptoms.

A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient?

Use another form of contraception for the next month." When beginning oral contraceptives, it is important that the patient use another form of contraception for the first month, because protection is not immediate

A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to:

clean the ring with warm water, reinsert it, and use condoms for 7 days. If a ring is expelled before 3 weeks have passed, it can be reinserted after being washed in warm water. If the ring has been out longer than 3 hours, backup contraception should be used for 7 days. Because this ring was expelled while the patient was sleeping, using backup contraception is prudent. Discarding the ring is not indicated if it can be cleaned. The ring should not be washed in hot water.

what three estrogen components are employed in combination oral contraceptives

ethanol, estradiol, mestranol and estradiol validate

A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to:

increased transmission of the human immunodeficiency virus (HIV). Spermicides that contain nonoxynol-9 have been linked to the increased transmission of HIV. Spermicides containing nonoxynol-9 have not been linked to HPV infections, spontaneous abortions, or endometrial cancer.

A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will:

reassure the patient that this is normal with this form of contraception. Patients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen.

A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to:

take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4. If one or two pills are missed during the second or third week of a 28-day cycle, the patient should be instructed to take one pill as soon as possible, continue the pack, skip the placebo pills, and go straight to a new pack. It is not necessary to use an alternative form of contraception. If three or more pills are missed, the risk of pregnancy increases.

A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring:

the day the last pill is taken and use backup contraception for 7 days. When patients who have been using a progestin-only OC begin using a vaginal ring, they should be instructed to insert the ring on the last day of the pill and use backup contraception for 7 days.

A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it:

within 7 weeks of conception."