Contraception NCLEX Questions
Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate? A) Take a mild analgesic if needed for menstrual pain. B) Avoid cold foods if menstrual pain persists. C) Stop exercise while menstruating. D) Avoid sexual intercourse during menstruation.
Answer: A 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 exercise during menstruation, which increases abdominal tone. Avoiding cold foods will not decrease dysmenorrhea. Sexual intercourse is not prohibited during menstruation, but the male partner should wear a condom to prevent exposure to blood.
Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following? A) Anemia. B) Hypertension. C) Dysmenorrhea. D) Acne vulgaris.
Answer: B 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 a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. 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 cycle. Use of oral contraceptives often improves 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. The nurse should instruct the client to do which of the following? A) Check the cervical mucus to see if it is thick and sparse. B) Take her temperature at the same time every morning. C) Document ovulation when the temperature decreases at least 1°F. D) Avoid coitus for 10 days after a slight rise in temperature.
Answer: B The basal body temperature method requires that the client take her temperature each morning before arising, preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temperature falls by 0.5°F. At the time of ovulation, the temperature rises 0.4° to 0.8°F because of increased progesterone secretion in response to the luteinizing hormone. The temperature 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 or 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 ovulation, 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 coitus when the cervical mucus is copious and for about 3 to 4 days before and after ovulation to avoid a pregnancy.
Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning? A) Douching with an acidic solution after intercourse is recommended. B) Diaphragms should not be used if the client develops acute cervicitis. C) The diaphragm should be washed in a weak solution of bleach and water. D) The diaphragm should be left in place for 2 hours after intercourse.
Answer: B The teaching plan should include a caution that diaphragms should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use of a 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 of the following instructions should be included in the nurse's teaching regarding oral contraceptives? a. Weight gain should be reported to the physician. b. An alternate method of birth control is needed when taking antibiotics. c. If the client misses one or more pills, two pills should be taken per day for 1 week. d. Changes in the menstrual flow should be reported to the physician.
Answer: B When the client is taking oral contraceptives and begins antibiotics, another method of birth control should be used. Antibiotics decrease the effectiveness of oral contraceptives. Approximately 5-10 pounds of weight gain is not unusual, so answer A is incorrect. If the client misses a birth control pill, she should be instructed to take the pill as soon as she remembers the pill. Answer C is incorrect. If she misses two, she should take two; if she misses more than two, she should take the missed pills but use another method of birth control for the remainder of the cycle. Answer D is incorrect because changes in menstrual flow are expected in clients using oral contraceptives. Often these clients have lighter menses.
. A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the client's teaching plan? a) About midway through the menstrual cycle, cervical mucus is thick and sticky. b) During ovulation, the cervix remains dry without any mucus production. c) As ovulation approaches, cervical mucus is abundant and clear. d) Cervical mucus disappears immediately after ovulation, resuming with menses.
Answer: C As ovulation approaches, cervical mucus is abundant and clear, resembling raw egg white. Ovulation generally occurs 14 days (plus or minus 2 days) before the beginning of menses. During the luteal phase of the cycle, 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 influences of estrogen and progesterone. Cervical mucus is always present.
Assessment of a 16-year-old nulligravid client who visits the clinic and asks for information on contraceptives reveals a menstrual cycle of 28 days. The nurse formulates a nursing diagnosis of Deficient Knowledge related to ovulation and fertility management. Which of the following would be important to include in the teaching plan for the client? A) The ovum survives for 96 hours after ovulation, making conception possible during this time. B) The basal body temperature falls at least 0.2°F after ovulation has occurred. C) Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. D) Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus.
Answer: C For a client with a menstrual cycle of 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 temperature rises 0.5° 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 copious.
Jessa, 17 years old, is bleeding between periods of less than two weeks. This condition is an abnormality in the menstrual cycle known as: a. Metrorrhagia b. Menorrhagia c. Amenorrhea d. Dysmenorrheal
Answer: A Abnormalities of Menstruation 1. Amenorrhea - absence of menstrual flow 2. Dysmenorrhea - painful menstruation 3. Oligomenorrhea - scanty menstruation 4. Menorrhagia -excessive menstrual bleeding 5. Metrorrhagia - bleeding between periods of less than 2 weeks
Estrogen, one of the hormones regulating cyclic activities in female reproductive system is responsible for which effect? a. Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13 cm. b. Inhibits the production of LH c. Increases endometrial tortuosity d. All of the above
Answer: A Effects of estrogen: • Inhibits the production of FSH • Causes hypertrophy of the myometrium • Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13 cm. Effects of Progesterone • Inhibits the production of LH • Increases endometrial tortuosity • Increased endometrial secretions • Facilitates transport of the fertilized ovum through the fallopian tubes
A nurse is reviewing a basal body temperature chart with a couple. Which change would indicate probable ovulation? a) A decrease in temperature followed by an increase for several days b) An increase in temperature followed by a decrease for several days c) A decrease in temperature that remains until menses begins d) A steadily increasing temperature over seven days
Answer: A At ovulation body temperature drops, then rises sharply and remains elevated for several days.
A 20-year-old woman desiring to use a cervical cap for family planning is instructed on its use. Which of the following client statements would indicate to the nurse that the client needs further instruction? A) "Cervical caps can be left in place longer than a diaphragm." B) "Using a cervical cap may increase the risk of irritation." C) "Cervical caps usually fit better than a diaphragm." D) "Many women are unable to use cervical caps."
Answer: C The client needs further instruction when she says that cervical caps fit better than the diaphragm. Many women are unable to use cervical caps because their cervix is too short for the cap to fit the cervix properly. A cervical cap may remain in place for up to 48 hours after intercourse, whereas it is recommended that a diaphragm be left in place for only 24 hours. The cervical cap is associated with cervical irritation.
A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions would the nurse include about the use of condoms as a method for family planning? A) Using a spermicide with the condom offers added protection against pregnancy. B) Natural skin condoms protect against sexually transmitted diseases. C) The typical failure rate for couples using condoms is about 25%. D) Condom users frequently report penile gland sensitivity
Answer: A The typical failure rate of a condom is approximately 12% to 14%. Adding a spermicide can decrease this potential failure rate because it offers additional protection against pregnancy. Natural skin condoms do not offer the same protection against sexually transmitted diseases caused by viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms do not prevent the passage of viruses. Most condom users report decreased penile gland sensitivity. However, some users do report an increased sensitivity or allergic reaction (such as a rash) to latex, necessitating the use of another method of family planning or a switch to a natural skin condom.
A adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by; a. Return preovulatory basal body temperature b. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle c. 3 full days of elevated basal body temperature and clear, thin cervical mucus d. Breast tenderness and mittelschmerz
Answer: C Ovulation (the period when pregnancy can occur) is accompanied by a basal body temperature increase of 0.7 degrees F to 0.8 degrees F and clear, thin cervical mucus. A return to the preovulatory body temperature indicates a safe period for sexual intercourse. A slight rise in basal temperature early in the cycle is not significant. Breast tenderness and mittelschmerz are not reliable indicators of ovulation.
After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching? A) "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case." B) "If I get pregnant, I will have to be refitted for another diaphragm after the delivery." C) "Before inserting the diaphragm I should coat the rim with contraceptive jelly." D) "If I gain or lose 20 pounds, I can still use the same diaphragm."
Answer: D A client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 pounds. Gaining or losing more than 15 pounds 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 for 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 delivery of a newborn because weight changes and physiologic 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 the diaphragm.
Which of the following would the nurse expect to include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning? a) Amenorrhea is a common side effect of IUDs. b) The client needs to use additional protection for conception. c) IUDs are more costly than other forms of contraception. d) Severe cramping may occur when the IUD is inserted.
Answer: D 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 time. Common side effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopic pregnancy may occur. The IUD has an effectiveness rate of 98%. Therefore, additional protection is not necessary to prevent pregnancy. IUDs 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.
A multigravid client will be using medroxyprogesterone acetate (Depo-Provera) as a family planning method. After the nurse instructs the client about this method, which of the following client statements indicates effective teaching? a) "This method of family planning requires monthly injections." b) "I should have my first injection during my menstrual cycle." c) "One possible side effect is absence of a menstrual period." d) "This drug will be given by subcutaneous injections."
Answer: C With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common side effects. Other side effects include weight gain, breakthrough bleeding, headaches, and depression. This method requires deep intramuscular injections every 3 months. The first injection should occur within 5 days after menses.
