Chapter 31: Family Planning

7. When instructing a client in the use of spermicidal foam or gel, it is important to include the information that: a. effectiveness is about 85%. b. douching should be avoided for at least 6 hours. c. it should be inserted 1 to 2 hours before intercourse. d. one application is effective for several hours.

ANS: B Douching within 6 hours of intercourse would remove the spermicide and increase the risk of pregnancy. Effectiveness is only 29% when used alone. The spermicidal foam or gel should be inserted 15 minutes before intercourse. One application is effective for about 1 hour. PTS: 1 DIF: Cognitive Level: Application REF: 695

5. Informed consent concerning contraceptive use is important because some of the methods: a. may not be reliable. b. require a surgical procedure to insert. c. have potentially dangerous side effects. d. are invasive procedures that require hospitalization.

ANS: C It is important for couples to be aware of potential side effects so they can make an informed decision about the use of contraceptives. Some contraceptives are not reliable but the side effects are the reason for the informed consent. A written consent is required if it involves a surgical procedure. Some contraceptive procedures are invasive but do not require hospitalization. PTS: 1 DIF: Cognitive Level: Understanding REF: 684

6. Which contraceptive method should be contraindicated in a client with a history of toxic shock syndrome? a. Condom b. Spermicide c. Cervical cap d. Oral contraceptives

ANS: C The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. A condom is not contraindicated with a history of toxic shock syndrome. Spermicide is not contraindicated with a history of toxic shock syndrome. Oral contraceptives are not contraindicated with a history of toxic shock syndrome. PTS: 1 DIF: Cognitive Level: Understanding REF: 694

13. A male client asks, "Why do I have to use another contraceptive? I had a vasectomy last week." The best response is: a. "A vasectomy is only 85% effective." b. "A vasectomy is not effective in all men." c. "Semen may contain sperm for 6 months following a vasectomy." d. "Complete sterilization doesn't occur until all sperm have left the system."

ANS: D It may take a month or longer for all sperm to be removed from the system. During that time, an additional method of contraception must be used. A vasectomy is more than 85% effective. Vasectomies have a high success rate but it may take 1 month for all the sperm to be removed from the system. After 1 month, all the sperm have usually been removed from the system. PTS: 1 DIF: Cognitive Level: Application REF: 687

17. The most appropriate statement for introducing the topic of family planning in the postpartum setting is: a. "What are your plans for future pregnancies?" b. "Do you plan on being sexually active in the future?" c. "Let's talk about birth control, because breastfeeding is not 100% effective for preventing pregnancy." d. "Here are some pamphlets on available methods of birth control. I'll come back later and discuss them with you."

ANS: A Discussing future pregnancy plans opens the conversation to ways of preventing pregnancy from occurring before the woman is ready. "Do you plan on being sexually active in the future?" will only provide a yes or no answer and not allow for conversation. The family needs to be ready to talk about birth control; the effect of breastfeeding on birth control is applicable only to the woman. Pamphlets are not always the best form of teaching; the woman is usually too tired and overwhelmed to read. PTS: 1 DIF: Cognitive Level: Application REF: 698

23. A client is using Depo-Provera as her method of birth control. Which finding warrants immediate intervention? a. Mid-cycle bleeding b. Nausea c. Temperature of 100° F d. Irregular periods

ANS: A When using Depo-Provera, the major side effect is irregular bleeding. The presence of mid-cycle bleeding warrants further investigation at this time so it is the priority assessment. PTS: 1 DIF: Cognitive Level: Application REF: 688

24. A client has had a prior history of endometriosis and comes to the clinic asking about which method of birth control might be helpful to alleviate her symptoms. Which birth control method should the client use? a. Withdrawal method b. Oral contraceptives c. Depo-Provera d. Intrauterine device (IUD)

ANS: B A client who has a history of endometriosis may gain additional benefit from using an oral contraceptive as her birth control method because hormone levels will be more uniformly regulated with this type of treatment. The withdrawal method and Depo-Provera will not provide any additional benefit relative to a history of endometriosis. An IUD may cause further irritation to the endometrial lining so it would not be a prudent choice. PTS: 1 DIF: Cognitive Level: Application REF: 689

14. A woman who has a successful career and a busy lifestyle will most likely look for which type of contraceptive? a. Requires extensive education to use b. Is the easiest and most convenient to use c. Costs the least d. Is permanent

ANS: B A woman who has a busy life will probably have less time to devote to contraceptive use, so she needs something that is easy and convenient. Extra time for education would not be acceptable for this woman. Cost would probably not be a problem with this woman. There is no indication that a woman who has a successful career and a busy lifestyle wants it to be permanent, just easy. PTS: 1 DIF: Cognitive Level: Understanding REF: 698

20. A client presents to the Women's Health Clinic for continuation of her contraceptive method. She has been using Depo-Provera (medroxyprogesterone acetate) for 24 months. In preparation for instituting a plan of care, the nurse would consider which option as a priority? a. Schedule the client for follow-up baseline diagnostic testing to confirm that the client is not pregnant. b. Obtain information for an alternate contraception method. c. Ask the client for additional information related to her menstrual cycle. d. Inspect the skin for site selection of contraceptive method.

ANS: B According to WHO (World Health Organization) guidelines, women should not be on Depo-Provera for more than 2 years because of bone density loss. Therefore, the nurse should include assessments for other types of contraception methods for the client. Although it may prove to be important to rule out possible pregnancy, based on the provided information, discontinuation of this method is the priority intervention. Depo-Provera can cause menstrual irregularities, but this is not the priority intervention. The nurse can follow up on this issue later. Because the current method of contraception should no longer be used, this option is not necessary. PTS: 1 DIF: Cognitive Level: Analysis REF: 688

8. Which symptom in a client using oral contraceptives should be reported to the physician immediately? a. 5-lb weight gain b. Leg pain and edema c. Decrease in menstrual flow d. Increased pigmentation of the face

ANS: B Oral contraceptives increase clotting factors, which place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain can be expected. A decrease in menstrual flow is an expected finding. Increased pigmentation of the face is a common finding. PTS: 1 DIF: Cognitive Level: Application REF: 689

22. Which of the following is a potential disadvantage for a client who wishes to use an intrauterine device (IUD) as a method of birth control? a. Insertion of the device prior to coitus resulting in decreased spontaneity b. Ectopic pregnancy c. Protection against STDs d. Decrease in dysmenorrhea

ANS: B The insertion of an IUD is done in a health care provider's office. An ectopic pregnancy can occur as a possible complication of the IUD. An IUD does not offer protection against STDs. A decrease in dysmenorrhea would be an advantage of using an IUD. PTS: 1 DIF: Cognitive Level: Application REF: 688, 690

19. You are teaching a group of adolescents about myths and facts related to contraception. Which statement indicates that additional teaching is needed for this group with regard to contraception? a. Adolescents are more likely to become pregnant even if they use available contraception methods correctly. b. The withdrawal technique provides a higher likelihood that a teen will not get pregnant. c. Pregnancy can occur in the presence or absence of orgasm. d. Pregnancy can occur even if a teen is menstruating at the time of coitus.

ANS: B The withdrawal technique does not decrease the likelihood of becoming pregnant for a teen because it is unreliable in application and, even without penetration, ejaculation can result in pregnancy. It is true that adolescents are more likely to become pregnant even if they correctly use available contraception methods, based on current clinical evidence, because they are more likely to have contraceptive failure in the context of decreased knowledge. It is also true that pregnancy can occur in the presence or absence of orgasm, and even if a teen is menstruating at the time of coitus. PTS: 1 DIF: Cognitive Level: Application REF: 685

15. The method of contraception that is considered the safest for women is a(n): a. IUD. b. diaphragm. c. male condom. d. oral contraceptive.

ANS: C A male condom does not have any side effects or risk factors for the woman. Oral contraception, an IUD, and the diaphragm all have significant side effects or risk factors for the woman. PTS: 1 DIF: Cognitive Level: Understanding REF: 694

1. Which contraceptive method provides protection against sexually transmitted diseases? a. Oral contraceptives b. Tubal ligation c. Male or female condoms d. Intrauterine device (IUD)

ANS: C Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease. Only the barrier methods provide some protection from sexually transmitted diseases. A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted diseases. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted diseases. PTS: 1 DIF: Cognitive Level: Understanding REF: 693

25. You are assessing a client in the clinic setting who has been taking oral contraceptives for several years, without side effects. Vital signs are stable and the client denies any pain or tenderness. On examination, you note a small erythematous area of approximately 2 cm on her right lower leg. She denies any traumatic injury and says this is a recent onset of a few days. Based on this information you would: a. instruct the client to use warm compresses for several days and keep the leg elevated as much as possible. b. have the client wear flats rather than heels to modify her gait and help alleviate this issue. c. refer the client to the health care provider for additional diagnostic work up. d. have the client take an over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) and return to the clinic if the problem persists.

ANS: C Because the client has a history of taking oral contraceptives, the nurse must assess and evaluate findings relative to ACHES (warning signs of oral contraceptives). Thus, the client should be worked up for the possibility of a superficial or deep vein thrombosis (DVT). Warm compresses and elevation of the leg, wearing flats, and taking an OTC NSAID may lead to further problems if there is an underlying clot that is not addressed promptly. PTS: 1 DIF: Cognitive Level: Application REF: 692

12. The client who has had an intrauterine device (IUD) inserted should be instructed to: a. use a vinegar douche weekly for 4 weeks. b. have the IUD replaced every 2 to 4 years. c. check the placement of the string once a week for 4 weeks. d. use another method of contraception for 2 weeks after insertion.

ANS: C Checking the placement of the string is necessary to determine whether the IUD is still correctly positioned. If the string is shorter or longer than when checked previously, she should contact her physician. A vinegar douche weekly for 4 weeks is not required. An IUD can be left in place for up to 10 years. A second method of contraception is not required after insertion of the IUD; it is effective immediately. PTS: 1 DIF: Cognitive Level: Application REF: 688

16. A client is 27 years old and delivered her first baby yesterday. She and her husband do not want to have another baby for at least 3 to 4 years. The best method of birth control to meet their needs is: a. withdrawal. b. fertility awareness method. c. combination of condoms and foam. d. vasectomy with a reversal in 3 years.

ANS: C Of the methods listed, condoms and foam would be the best for this couple. Withdrawal is the least effective form of birth control. Fertility awareness is not that effective and an unwanted pregnancy could result. They want another child so a vasectomy with a reversal would not be an appropriate option. PTS: 1 DIF: Cognitive Level: Application REF: 680, 681

10. When using the basal body temperature method of family planning, the woman should know that: a. she will remain fertile for 5 days after ovulation. b. she should take her temperature each night before going to bed. c. her temperature will increase about 0.4° to 0.8° F after ovulation. d. her temperature is normally lower during the second half of her cycle.

ANS: C The basal body temperature will increase about 0.4° to 0.8° F when ovulation occurs. The woman is fertile for up to 18 days. She should take her temperature on rising in the morning. A woman's temperature is usually higher in the second half of her cycle. PTS: 1 DIF: Cognitive Level: Understanding REF: 696

21. Which of the statements is correct regarding use of contraception and the occurrence of sexually transmitted diseases (STDs)? a. As long as the oral contraception method is used correctly, there is no transmission of STDs during sexual activity. b. Oral contraceptives provide the greatest protection against getting STDs. c. Barrier methods, if used correctly, are more likely to protect individuals from STDs as compared with other contraceptive methods. d. It is less likely to see transmission of STDs if clients engage in oral sex as opposed to vaginal penetration.

ANS: C The correct use of barrier methods helps protect against the transmission of STDs compared with other methods of contraception. The use of oral contraceptives has no effect on the transmission of STDs. The effectiveness of oral contraceptives is increased related to the prevention of pregnancy compared with other methods with the exception of abstinence. The method of sexual activity does not affect the transmission of STDs. PTS: 1 DIF: Cognitive Level: Application REF: 693

11. The major difference between the diaphragm and the cervical cap is that the diaphragm: a. is more effective. b. requires spermicide. c. applies pressure on the urethra. d. has no contribution to toxic shock syndrome.

ANS: C The diaphragm is made to fit snugly in the vaginal area and contains a hard rim that may put pressure on the urethra. The cervical cap is smaller and fits around the cervix. The cervical cap is not more effective than a diaphragm. The diaphragm does not require spermicide. Both may contribute to toxic shock syndrome. PTS: 1 DIF: Cognitive Level: Analysis REF: 694

18. In reviewing information related to the occurrence of pregnancies using a focus group discussion with women, concern was expressed that many of them had problems using their respective type of contraception and, as a result, became pregnant. Based on this information, the nurse would incorporate which of the following in a teaching plan for group members? a. Provide information relative to product recalls of contraceptive devices. b. Have the clients keep a contraceptive diary related to the consistency of using methods because it is apparent that they forgot to use their preferred method as directed. c. Have the clients consider switching to a different form of contraception because the contraception did not prevent pregnancy for them. d. Plan for assessing the clients' knowledge related to the contraception methods and provide information to increase the knowledge base so that the effectiveness rate would improve.

ANS: D A typical effectiveness rate refers to the occurrence of pregnancy while using contraception methods. If contraception is used correctly and consistently, pregnancy should not occur. A decreased effectiveness rate is associated with incorrect usage in terms of application or inconsistent use. Providing information relative to product recalls of contraceptive devices refers to an ideal effectiveness rate; the implication is that the contraception method, although used correctly, is at fault. There is no evidence to support this finding. Having the client keep a contraceptive diary does not address the primary concerns related to the typical effectiveness rate. Having the client switch methods may not be necessary because the primary focus is to determine the knowledge base and identify learning needs. PTS: 1 DIF: Cognitive Level: Synthesis REF: 683

3. Which client is a safe candidate for the use of oral contraceptives? a. 39-year-old with a history of thrombophlebitis b. 16-year-old with a benign liver tumor c. 20-year-old who suspects she may be pregnant d. 43-year-old who does not smoke cigarettes

ANS: D Heavy cigarette smoking is a contraindication. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant, preclude the use of oral contraceptives. Pregnancy is a contraindication. PTS: 1 DIF: Cognitive Level: Understanding REF: 689

2. A nurse is leading a discussion regarding birth control measures. Which method is considered the most reliable method? a. Coitus interruptus b. Breastfeeding c. Natural family planning d. Intrauterine device

ANS: D IUDs are 98% effective. Although coitus interruptus is considered 81% effective, it requires great control by the man and may be unsatisfying for both partners. Only women who breastfeed every 2 hours around the clock may avoid ovulation. Another method should be used when the frequency of breastfeeding decreases. Couples must be highly motivated to use natural family planning because they must abstain from sex for as much as half of their cycle. Errors in the forbidden time carry a very high risk of pregnancy. PTS: 1 DIF: Cognitive Level: Understanding REF: 682

9. Which response by the nurse is most appropriate when a client asks, "What contraceptive do you think I should use?" a. "Ask your doctor. She will know what is best for you." b. "The male condom is probably the easiest for you to use." c. "Because you are younger than 40, you should use oral contraceptives." d. "I can discuss the various methods with you so you can decide what is best."

ANS: D The nurse should provide the woman with all the necessary information to make an informed decision but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her. PTS: 1 DIF: Cognitive Level: Application REF: 680-682

4. The role of the nurse in family planning is to: a. refer the couple to a reliable physician. b. decide on the best method for the couple. c. advise couples on which contraceptive to use. d. educate couples on the various methods of contraception.

ANS: D The nurse's role is to provide information to the couple so that they can make an informed decision about family planning. The nurse can help the couple; they do not need to be sent to a physician. The nurse's role is to educate, not decide for the couple which is the best method or advise couples on which contraceptive to use. PTS: 1 DIF: Cognitive Level: Application REF: 686, 687