Nursing 158 contraception Final exam

Vaginal ring

3 weeks of continuous use followed by a ring free week Combo - Does not need to be fitted Education- timely insertions and what to do in case of accidental expulsion lower dose of hormones due to direct absorption in vagina Offers symptom relief for those that suffer with AUB and PCOS

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

A Using a spermicide with the condom offers added protection against pregnancy.

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.

B) An alternate method of birth control is needed when taking antibiotics

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.

B) Take her temperature at the same time every morning.

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

B: Hypertension

Contraception

Behavioral Methods: Abstinence Fertility awareness Withdrawal Standard days method

Progestin only pills ( mini pill)

Beneficial for women that can not have estrogen (women older than 35 that smokes) Breakthrough bleeding and higher risk of pregnancy than combination pill Disadvantages- can not take if previous ectopic pregnancy, ovarian cysts or hyperlipidemia

A multigravida 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."

C) "One possible side effect is absence of a menstrual period."

The nurse is discussing contraceptive options with a woman who is interested in information about intrauterine contraception (IUC). Which statement should the nurse include when discussing the disadvantages of these devices? A) "This type of contraceptive causes loss of bone density." B) "These require the use of daily medication." C) "The device may cause cramping and heavier bleeding." D) "You will need to insert the device daily."

C) "The device may cause cramping and heavier bleeding."

Regarding emergency contraception pills, nurses should be aware that A) The pills must be taken no later than 48 hours after unprotected intercourse or birth control mishap. B) The pills protect the woman against pregnancy even if she engages in unprotected intercourse in the days after treatment. C) The pill should be taken as soon as possible but up to 5 days after intercourse. D) Emergency contraception has no medical contraindications.

C) The pill should be taken as soon as possible but up to 5 days after intercourse.

Fertility awareness

Cervical mucus ovulation method Basal body temperature Symptothermal method Standard days method

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about it's 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."

D "If I gain or lose 20 pounds, I can still use the same diaphragm."

A married couple is discussing male and female sterilization with the nurse. Which statement is most appropriate for the nurse to make? A) "Male and female sterilization methods are 100% effective." B) "A vasectomy may have a slight effect on sexual performance." C) "Tubal ligation can be easily reversed if you change your mind in the future." D) "Major complications after sterilization are rare."

D) "Major complications after sterilization are rare."

Nursing assessment contraception

Medical History: smoking status, cancer of reproductive tract, migraines, HTN, thromboembolic disorder OB/GYN history: menstrual disorders, current contraception, previous STI and PID, sexual activity Physical Exam: height and weight, blood pressure, pelvic exam Diagnostic testing: UA, CBC, Pap smear, STI/HIV test

Emergency contraception

Must be taken within 72 but up to 120 hours of unprotected intercourse to prevent pregnancy Effectiveness decreases over time, so best to take soon rather than later Contraindication: known pregnancy as defined as implantation Risk of ectopic pregnancy if EC fails Education: does not offer STI protection, can not be used in place of regular birth control method, may delay next menses

Initial Elements of Contraceptive Counseling

Safety Effectiveness Availability (including accessibility and affordability) Acceptability Voluntary informed consent of contraceptive methods is an essential guiding principle of contraceptive counseling. Appropriate contraception counseling is an important contributor to the successful use of conceptive methods.

Combination oral contraception

Suppressed ovulation by adding estrogen and progesterone which mimics pregnancy Must be taken at the same time each day Advantages: regulates menstrual cycle, decreases heavy flow and cramps, reduces ovarian and endometrial cancer Disadvantages: no protections against STI, risk for venous thrombosis/emboli, increased risk for stroke and HTN especially in women that smoke, must take same time every day!

Transdermal patches

applied WEEKLY for 3 weeks then one week patch free: combo Side effects: increased risk of venous thromboembolism Note- decreased effectiveness in women over 198 lbs.

Standard days method

avoiding days 8 to 19 of a 28 day cycle

Contraceptive Sponge

can be inserted up to 24 hours before and must be left in for 6 hours post; offers protections for up to 12 hours but should not be left in for more than 30 hours to prevent TSS Does not protect against STI

Contraindication cervical cap

cervical cancer, UTI, TSS and should not be used during menstruation

Condoms Con

decreased sensation, interferes with spontaneity, breakage risk Female: 21% failure rate

Injectable contraceptives

effective for up to 3 months: Progestin only Side effects- depression, weight gain, menstrual cycle disturbances, delay in returned fertility after stopping Long term use (over 2 years) may affect bone mineral density Can be used by smokers and lactating women

Female condom Con

expensive for frequent use, noisy during sex

Withdrawal

failure is 18 to 22%

Tubal ligation

fallopian tubes are tied/cut or blocked to prevent conception, permanent, counsel both partners.

Intrauterine contraceptives

hormonal or non-hormonal Inhibition of sperm mobility and sperm viability Makes the endometrium of the uterus hostile to implantation Viable alternatives to hysterectomy and endometrial ablation in women with AUB Does not offer STI protection Education- must teach to check for strings

Diaphragm

if change in weight may need to be refitted for new size User controlled and non-hormonal

Basal body temperature

lowest temperature upon awakening - temp drops day before ovulation and then begins to rise

Cervical mucus ovulation method

mucus is abundant, clear, slippery and smooth

LAM

only effective during first 6 months before infant begins solids and infant must be breastfed on demand (1-2% failure rate)

Condoms

provides protection against STI Male- 15% failure rate Low cost and safe

Symptothermal method

relies on a combo of techniques (all the above plus ovulation pain, breast tenderness, etc)

Vasectomy

sealing, tying or cutting the vas deferens, difficult to reverse, counsel both partners

Cervical Cap

smaller than diaphragm and only covers the cervix - applies with suction (non-hormonal) Can be applied 36 hours before and provides protection for 48 hours

Implantable contraceptives

subdermal time release method that delivers synthetic progestin (estrogen free) Effective for 3 years and low dose of hormones Side effects: irregular bleeding, headaches, weight gain, acne, depression, anemia related to heavy bleeding Does not offer STI protection