PrepU Query Quiz: Sexuality

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is a) "You will be unable to have children." b) "You will continue having your menses every month." c) "You will experience menopause now." d) "You will need to practice birth control measures."

"You will need to practice birth control measures." Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

A client has just begun taking an oral contraceptive that contains estrogen and progestin. The nurse should instruct the client to use additional methods of contraception for at least: a) 7 days. b) 1 month. c) 2 months. d) 2 weeks.

7 days. Because of the mechanism of action of oral contraceptives, the onset of action is somewhat delayed. Full contraceptive benefits don't occur until an oral contraceptive agent has been taken for at least 7 days.

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? a) Clients with a pregnancy before age 20 b) Clients infected with the human papillomavirus (HPV) c) Clients with a long history of hormonal contraceptive use d) Clients with a history of recurrent candidiasis

Clients infected with the human papillomavirus (HPV) HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives don't increase the risk of cervical cancer.

A sexually active teenager seeks counseling from the school nurse about prevention of sexually transmitted infection (STI). Which contraceptive measure should the nurse recommend? a) Rhythm method b) Prophylactic antibiotic use c) Withdrawal method d) Condom and spermicide use

Condom and spermicide use Prevention of STIs is the primary concern of health care professionals. Barrier contraceptive methods, such as condoms with the addition of spermicide, seem to offer the best protection for preventing STIs and their serious complications. The other contraceptive choices don't prevent the transmission of an STI. Antibiotics can't be taken throughout the life span.

A nurse is preparing a presentation about contraception for a young adult community group. Which of the following would the nurse expect to address as the most effective means of contraception? a) Barrier methods b) Sterilization c) Abstinence d) Hormonal contraception

Abstinence Abstinence is the only completely effective means of contraception. It is followed by sterilization. Hormonal contraceptives and barrier methods are effective but they must be used consistently to be effective.

A nurse is obtaining a 40-year-old male's health history before performing a physical examination. Which of the following information would most likely not be obtained? a) Premature ejaculation or other concerns of a sexual nature b) Age of first ejaculate c) Pain during sexual intercourse d) Contraceptive practices

Age of first ejaculate Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.

A woman is taking oral contraceptives. The nurse teaches the client that medications that may interfere with oral contraceptive efficacy include: a) antihypertensives. b) antihistamines. c) antibiotics. d) diuretics.

Antibiotics. Broad-spectrum antibiotics can cause decreased efficacy of oral contraceptives, placing the client at risk for an unplanned pregnancy. When a client is prescribed a course of antibiotics, a back-up method of contraception should be used. Antihypertensives, diuretics, and antihistamines do not interfere with oral contraceptive efficacy.

The nurse working at a family planning clinic evaluates a client's risk for complications from oral contraceptives. Which of the following places the client at highest risk? a) Age less than 35 b) Smokes 1 pack cigerettes per week c) Drinks 1 glass of wine daily d) History of diabetes

Smokes 1 pack cigerettes per week Complications for oral contraceptives include an increased incidence of blood clots, heart attacks, and stroke, especially in women who smoke.

The community health nurse is aware that many factors influence a client's decision for contraception. Which of the following is the most likely reason a client would select permanent contraception? a) To reduce the risk of sexually transmitted diseases. b) The desire to have multiple sex partners. c) Religious beliefs which prevent reproduction. d) The choice not to start a family.

The choice not to start a family. Some people choose a permanent method to prevent pregnancy from ever occurring. Factors that affect a person?s choice of a contraceptive method include age, marital status, desire for future pregnancy, religious beliefs, level of education, cost, and ease of use. Permanent contraception offers no protection against sexually transmitted infections.

A nurse is teaching a group of clients about birth control methods. When providing instruction about subdermal contraceptive implants, the nurse should cite which feature as the main advantage of this method? a) The implants provide effective, continuous contraception that isn't user dependent. b) The implants cost less over the long term than other contraceptive methods. c) The implants require a lower hormonal dose than other hormonal contraceptive methods. d) The implants can be removed easily if pregnancy occurs.

The implants provide effective, continuous contraception that isn't user dependent. Although all of the options accurately describe features of subdermal contraceptive implants, the main advantage of this contraceptive method is effective, continuous contraception that isn't user dependent. The effectiveness of other methods, such as the condom, diaphragm, and oral contraceptives, depends at least partly on the user's knowledge, skills, and motivation.

A 12-year-old adolescent is being seen in the primary care office where you practice nursing. She has just had her first menses, and you are advising her on how to use a tampon. Your instructions include using the least absorbent tampon and to change tampons frequently, at least every 4 to 6 hours. Which of the following conditions are you most likely trying to prevent? a) Toxic shock syndrome b) Cervicitis c) Pelvic inflammatory disease d) Vaginitis

Toxic shock syndrome TSS is a type of septic shock that is a life-threatening systemic reaction to the toxin produced by several kinds of bacteria. TSS is associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptive devices that remain in place longer than necessary.

A teenage female is in the community health clinic seeking contraception. The community health nurse demonstrates effective health promotion and prevention with the client when including which of the following in the health education teaching plan? a) Contraception plans prior to initiation of sexual activity. b) Correct use of the contraception method selected. c) The need for a back-up contraceptive method when using antibiotics. d) The importance of using a barrier method to prevent risk of HIV transmission.

Contraception plans prior to initiation of sexual activity. The prevention of unwanted pregnancy must be a conscious decision. Anyone who is unprepared for pregnancy should refrain from intercourse or obtain a contraceptive method from a healthcare provider or from the pharmacy; it is too late to think about contraception during sexual intercourse. To practice responsible sexuality, the contraceptive method must be used consistently and according to instructions.

A client is prescribed a combination hormonal contraceptive. The nurse would instruct the client to report which of the following immediately? a) Nausea b) Mood changes c) Difficulty hearing d) Headaches

Headaches A client taking combined hormonal contraceptives should report the following immediately: abdominal pains, chest pains, headaches, eye problems, and severe leg pains. Although nausea and mood changes are bothersome adverse effects, they do not need to be reported immediately. Difficulty hearing is not associated with combined hormonal contraceptive use.

A young female client is receiving chemotherapy and mentions to the nurse that she and her husband are using a diaphragm for birth control. Which information is most important for the nurse to discuss? a) transmission of sexually transmitted diseases b) inconvenience of the diaphragm c) body changes related to hormones d) infection control

Infection control The risk of becoming neutropenic during chemotherapy is very high. Therefore, an inserted foreign object such as a diaphragm may be a nidus for infection. Although the nurse may wish to inform the client about the ease with which various contraceptive modalities may be used, the focus of this discussion should be on preventing an infection, which can be fatal for the neutropenic client. There are no data to suggest the client is at risk for acquiring a sexually transmitted disease. The client will not be experiencing body changes directly related to hormonal changes.

A nurse is conducting a healthy-living workshop with a group of female college students. Which of the following methods of contraception should the nurse recommend as a means of preventing both pregnancy and sexually transmitted infections? a) Condoms. b) Oral contraceptives. c) Coitus interruptus. d) Intrauterine devices (IUD).

Condoms. Coitus interruptus, oral contraceptives, and IUDs provide no protection against STIs, while condoms provide significant (but imperfect) protection against both pregnancy and STIs.

Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement? a) Continue previous contraceptive use even if you're experiencing amenorrhea. b) This medication may result in heightened libido. c) Incidence of dysmenorrhea may increase while taking this drug. d) Amenorrhea is irreversible.

Continue previous contraceptive use even if you're experiencing amenorrhea. Women may experience amenorrhea, which is reversible, while taking antipsychotics because amenorrhea doesn't indicate cessation of ovulation the client who experiences amenorrhea can still become pregnant. She should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and the depressant effect generally decreases libido.

A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug? a) ampicillin b) omeprazole c) indomethacin d) amitriptyline

Ampicillin Oral contraceptives may interact with other medications, and the effectiveness may be decreased if the client is prescribed ampicillin, tetracycline, or anticonvulsants, such as phenytoin. Indomethacin, an anti-inflammatory agent; amitriptyline, an antidepressant agent; and omeprazole, a drug used to suppress gastric acid secretion, do not decrease the effectiveness of oral contraceptives.

A client who has received a new prescription for oral contraceptives asks the nurse how to take them. Which symptom should the nurse instruct the client to report to her primary caregiver? a) Decreased menstrual flow b) Breakthrough bleeding within first 3 months of use c) Breast tenderness d) Blurred vision and headache

Blurred vision and headache Some adverse effects of birth control pills, such as blurred vision and headaches, require a report to the health care provider. Because these two effects in particular may result in cardiovascular compromise and embolus, the client may need to use another form of birth control. Breast tenderness, breakthrough bleeding, and decreased menstrual flow may occur as a normal response to the use of birth control pills.

A 35-year-old African American who is a regular smoker visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. She is also diabetic. Which of the following contraceptive methods is best for this patient? a) Clomiphene (Clomid) therapy b) NuvaRing placement c) Menotropins (Repronex) therapy d) Cervical cap

Cervical cap Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not utilize hormonal therapy and are appropriate in this case. Menotropins (Repronex, Pergonal), a combination of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), may be used to stimulate the ovaries to produce eggs. NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) is a combination hormonal contraceptive that releases estrogen and progestin and is contraindicated for this patient.

In which group is it most important for the client to understand the importance of an annual Papanicolaou (Pap) test? a) Clients with a pregnancy before age 20 b) Clients infected with the human papillomavirus (HPV) c) Clients with a long history of oral contraceptive use d) Clients with a history of recurrent candidiasis

Clients infected with the human papillomavirus (HPV) HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of oral contraceptives don't increase the risk of cervical cancer.

A nurse is explaining premenstrual syndrome to a female client. The nurse knows that the client understands when the client states that which of the following appears before menstruation? a) Calmness b) Water loss c) Headache d) Fatigue

Headache Menstrual cycle-related distress, commonly called premenstrual(tension) syndrome (PMS), is characterized by the appearance of one or more of the following several days before the onset of menstruation: irritability, emotional tension, anxiety, mood changes, headache, breast tenderness, and water retention.

The nurse knows that women may choose periodic abstinence for several reasons. In order to assist the client in her choice to return to sexual activity, while preventing pregnancy, the nurse should make sure to discuss which of the following with the client? a) how to use a temporary contraceptive method b) the need for frequent pregnancy testing c) how to chart her fertility pattern d) the need for a barrier method

How to chart her fertility pattern Periodic abstinence and fertility awareness methods are two methods of contraception that involve charting a woman?s fertility pattern. Periodic abstinence is a method used by some sexually active women to prevent pregnancy. They become familiar with their fertility patterns and abstain from vaginal intercourse on the days they think they could become pregnant. Women who monitor their fertility to prevent pregnancy either abstain from vaginal intercourse for at least one third of each menstrual cycle or use barrier methods during the fertile or ?unsafe? period.

A postpartum client visits her physician to discuss contraception. After a thorough discussion, the client decides to use hormonal contraceptives. The physician orders ethinyl estradiol-ethynodiol diacetate, one tablet by mouth daily, followed by 7 days without a dose before beginning the next cycle of tablets. Which type of combination hormonal contraceptive is ethinyl estradiol-ethynodiol diacetate? a) Progestin-dominant triphasic b) Monophasic c) Biphasic d) Triphasic

Monophasic Ethinyl estradiol-ethynodiol diacetate is a monophasic oral contraceptive agent.

An adolescent female is prescribed amoxicillin for an ear infection. The nurse should teach the adolescent about the risks associated with her concurrent use of: a) OTC antihistamines. b) ibuprofen. c) multiple vitamins. d) oral contraceptives.

Oral contraceptives. When a person is taking amoxicillin as well as an oral contraceptive it renders the contraceptive less effective. Because pregnancy can occur in such a situation, the nurse should advise the client to use additional means of birth control during the time she is taking the antibiotic. There are no risks associated with the concurrent use of amoxicillin and OTC antihistamines, vitamins, or ibuprofen.

The community health nurse is preparing for a family planning clinic. The nurse knows the following factors influence contraceptive choices. (Select All That Apply) a) Religious beliefs b) Desire for future pregnancy c) Age d) Level of education e) Economic status f) Marital status g) Culture

• Age • Marital status • Desire for future pregnancy • Religious beliefs • Level of education Some people choose a permanent method to prevent pregnancy from ever occurring. Factors that affect a person?s choice of a contraceptive method include age, marital status, desire for future pregnancy, religious beliefs, level of education, cost, and ease of use. Culture and economic status are not documented as known factors that influence a person's choice of contraception.

A client has decided to use a transdermal contraceptive patch. The nurse instructs her that she can apply the patch to which area? Select all that apply. a) Thighs b) Torso c) Chest d) Arms e) Breasts

• Chest • Torso • Arms • Thighs A transdermal contraceptive patch can be applied to the torso, chest, arms, or thighs. It should not be applied to the breasts.

When developing a teaching plan about contraception with a 37-year-old woman during her annual gynecologic examination, which should the nurse identify as contraindications to combined oral contraceptive use? Select all that apply. a) smoking 1 pack of cigarettes per day b) multiple sexual partners c) history of asthma d) use of phenytoin for a seizure disorder e) mother with a history of lymphoma f) healing of a currently casted fractured femur.

• smoking 1 pack of cigarettes per day • healing of a currently casted fractured femur. • use of phenytoin for a seizure disorder Absolute contraindications to oral contraceptives include prolonged immobilization or surgery to the leg and age of more than 35 years when a cigarette smoker, especially in those women who smoke more than 20 cigarettes a day. Oral contraceptives also interact with many antiepileptic drugs including phenytoin, causing a reduction in the therapeutic dose and alteration in the seizure threshold. Multiple sexual partners is not a contraindication and is often a lifestyle situation in which pregnancy is undesired. Women with asthma can safely take oral contraceptives. There is no link between maternal or personal history of lymphoma and oral contraceptives.

A client is taking a progestin-only oral contraceptive, or minipill. When teaching the client about this medication, a nurse should include information on signs and symptoms of: a) endometriosis. b) tubal or ectopic pregnancy. c) premenstrual syndrome. d) female hypogonadism.

Tubal or ectopic pregnancy. Women taking the minipill have a higher incidence of tubal and ectopic pregnancies, possibly because progestin slows ovum transport through the fallopian tubes. Endometriosis, female hypogonadism, and premenstrual syndrome aren't associated with progestin-only oral contraceptives.

Which of the following dinner selections demonstrates an understanding of nutritional therapy used by women to decrease the signs and symptoms of menopause? a) Wheat toast, apple slices, broiled chicken breast, and steamed carrots b) Saltine crackers, fruit cocktail, lima beans, and meatloaf c) Corn chips, grapes, lean meat, and baked beans d) White toast, apple sauce, grilled chicken, and glazed carrots

Wheat toast, apple slices, broiled chicken breast, and steamed carrots To decrease the signs and symptoms of menopause, women are encouraged to decrease their fat and caloric intake and increase their intake of whole grains, fiber, fruit, and vegetables. Saltine crackers, white toast, and corn chips are not good sources of fiber. Fruit cocktail, applesauce, and grapes are high in artificial and natural sugars. Meatloaf is high in fat. Glazed carrots and baked beans can be high in sugar content.

The nurse is providing care to a group of clients in an acute care facility. The client most likely to prefer a room that is warm as well as wearing thermal blankets is the client who is a) going through menopause. b) aged 74 years. c) a teenager. d) 6 months pregnant.

Aged 74 years. Older clients, such as the one aged 74 years, may prefer to have a room that is warm and being provided with thermal blankets.

The nurse instructs a female client about contraceptive options. The nurse explains that the intrauterine device (IUD) is a good contraceptive option for women who: a) Are in a monogamous relationship. b) Desire short-term use of a contraceptive. c) Have a history of sexually transmitted diseases (STDs). d) Have had a history of ectopic pregnancies.

Are in a monogamous relationship. The IUD is suitable for clients who desire long-term contraceptive use and are in a monogamous relationship. Because of the increased risk of infection with an IUD if an STD occurs, the device is not appropriate for women with multiple partners or a history of STDs. Previous ectopic pregnancy is also a contraindication for an IUD because the incidence of ectopic implantation is slightly higher.

The nurse is reviewing the medical record of a client who has come to the clinic for contraception. The nurse determines that hormonal contraceptives would be inappropriate based on the client's history of which of the following? a) Controlled hypertension b) Severe acne c) An irregular menstrual cycle d) Migraine headaches with visual auras

Migraine headaches with visual auras Absolute contraindications to the use of hormonal contraceptives include a history of migraine headaches with visual auras. Hypertension if controlled in an otherwise healthy young nonsmoker is not a contraindication for the use of combination agents. However, the client would require a low dose and careful monitoring. Hormonal contraceptives may decrease acne in some situations and help to establish a regular bleeding cycle. Neither acne nor an irregular menstrual cycle is a contraindication.

Which oral contraceptive is considered safe for use while breastfeeding because it will not affect the breast milk supply once breastfeeding has been well established? a) estrogen b) testosterone c) estrogen and progestin d) progestin

Progestin Progestin alone has no effect on breast milk or breastfeeding once the milk supply is well established. Estrogen suppresses milk output. Testosterone is not given as an oral contraceptive.

The nurse is discussing the use of hormonal contraception with a woman who just delivered twins and is not ready to get pregnant in the near future. Which methods might the nurse recommend? (Select all that apply.) a) Vaginal sponge b) Norplant system c) Vaginal ring d) Oral contraceptives e) Intrauterine device f) Depo-Provera

• Depo-Provera • Oral contraceptives • Vaginal ring • Norplant system Oral contraceptives, Norplant, Depo-Provera, and a vaginal ring are all forms of hormonal contraception. A vaginal sponge is considered a barrier method and the method of contraception involving an intrauterine device is unknown.

The forensic nurse is caring for a client who was raped four days ago. Which of the following could the nurse teach the client is an effective contraceptive? a) Depo-Provera injection b) Insertion of a copper intrauterine device (IUD) c) Transdermal contraceptive patch d) Use of the Norplant system

Insertion of a copper intrauterine device (IUD) Emergency contraception is provided in two ways: increased doses of oral contractptive pills (usually within 72 hours) or insertion of a copper IUD within 5-7 days after unprotected intercourse. The other options are used for routine contraception.

A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the client's history, which finding would alert the nurse to a possible contraindication to using these agents? a) urinary tract infections b) menorrhagia c) thrombophlebitis d) ulcerative colitis

Thrombophlebitis Oral contraceptives are contraindicated for clients with a history of thrombophlebitis because a serious side effect of oral contraceptives is thrombus formation. Other contraindications include stroke and liver disease. Oral contraceptives are used cautiously in clients with hypertension or diabetes. Close follow-up of these clients is essential. Urinary tract infections (UTIs) do not contraindicate the use of oral contraceptives. If the client is suffering from UTIs, the nurse can instruct her to increase her fluid intake and wipe from front to back after urinating or defecating. Ulcerative colitis does not contraindicate using oral contraceptives. Menorrhagia is typically reduced through the use of oral contraceptives.

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? a) Use of corticosteroids b) Nulliparity c) Menopause d) Use of spermicidal jelly

Use of corticosteroids A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.

*A client has decided to use a transdermal contraceptive patch. The nurse instructs her that she can apply the patch to which area? Select all that apply.* a) Arms b) Thighs c) Breasts d) Torso e) Chest

• Chest • Torso • Arms • Thighs A transdermal contraceptive patch can be applied to the torso, chest, arms, or thighs. It should not be applied to the breasts.

The nurse documents the following history obtained from a female patient: No known allergies Douching 2 to 3 times per week Use of barrier methods for contraception Recent viral upper respiratory infection Estrogen levels within acceptable parameters Which of the following would the nurse identify as a risk factor for the patient developing a vulvovaginal infection? a) Barrier contraception b) Douching c) Normal estrogen levels d) Viral upper respiratory infection

Douching Risk factors for vulvovaginal infections include frequent douching, allergies, oral contraceptive use, use of broad-spectrum antibiotics (for bacterial infections), and low estrogen levels.

A nurse is working with a young woman who has been diagnosed with premenstrual syndrome (PMS) to develop a plan to alleviate her symptoms. Which of the following would be most appropriate to include in this plan? a) Engaging in a regular exercise program b) Decreasing water intake c) Avoiding the intake of whole grains and fruits d) Planning work during the days of PMS

Engaging in a regular exercise program Appropriate interventions include engaging in a regular exercise program, eating whole grains and fruits, planning work activities to accommodate the days client is less productive, and increasing water intake.

The nurse should instruct a woman taking folic acid supplements for folic acid-deficiency anemia that: a) folic acid should be taken on an empty stomach. b) it will take several months to notice an improvement. c) iron supplements are contraindicated with folic acid supplementation. d) oral contraceptive use, pregnancy, and lactation increase daily requirements.

Oral contraceptive use, pregnancy, and lactation increase daily requirements. Oral contraceptive use, pregnancy, and lactation are situations that increase demand for folic acid. With supplementation, a response should cause the reticulocyte count to increase within 2 to 3 days after therapy has begun. It is not necessary to take folic acid on an empty stomach. A client may safely take both iron and folic acid supplementation.

A client tells the nurse that she has had sexual contact with someone whom she suspects has genital herpes. The nurse should instruct the client to: a) anticipate lesions within 25 to 30 days. b) drink extra fluids to prevent lesions from forming. c) continue sexual activity unless lesions are present. d) report any difficulty urinating.

Report any difficulty urinating. The client should be encouraged to report painful urination or urinary retention. Lesions may appear 2 to 12 days after exposure. The client is capable of transmitting the infection even when asymptomatic, so a barrier contraceptive should be used. Drinking extra fluids will not stop the lesions from forming.

A female client is treated for trichomoniasis with metronidazole. The nurse instructs the client that: a) her partner does not need treatment. b) she should discontinue oral contraceptive use during this treatment. c) the medication should not alter the color of the urine. d) she should avoid alcohol during treatment and for 24 hours after completion of the drug.

She should avoid alcohol during treatment and for 24 hours after completion of the drug. Metronidazole can cause a disulfiram-like reaction if it is taken with alcohol. Tachycardia, nausea, vomiting, and other serious interaction effects can occur. Flagyl will make the urine a darker color. Oral contraceptives should never be discontinued with trichomoniasis. The partner also requires treatment to prevent retransmission of infection.

A nurse is preparing a presentation to a group of female adolescents about pelvic inflammatory disease (PID). Which statement best reflects the focus of preventive education needs for this age group? a) There are long-term complications related to reproductive tract infections. b) The use of hormonal contraceptives decreases the risk of PID. c) There are risks of defects in future infants born to adolescents with PID. d) Poor hygiene practices increase the risk of PID.

There are long-term complications related to reproductive tract infections. Long-term complications of PID include abscess formation in the fallopian tubes and adhesion formation leading to an increased risk of ectopic pregnancy or infertility. PID isn't prevented by proper personal hygiene or by any form of contraception, even though some forms of contraception, such as the male or female condom, do help to decrease the incidence. PID does not increase the risk of birth defects in infants born to adolescents with PID.

A 51-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that she has been experiencing severe hot flashes, but that she is reluctant to begin hormone therapy (HT). What potential solution should the nurse discuss with the patient? a) Sodium restriction b) Adopting a vegan diet c) Vitamin supplements d) Massage therapy

Vitamin supplements For some women, vitamins B6 and E have proven beneficial for the treatment of hot flashes. Sodium restriction, vegan diet, and massage have not been noted to relieve this symptom of perimenopause.

A nurse who will be working at a health fair is preparing a presentation on reproductive health and contraception. Which of the following would the nurse expect to include as advantages of combined hormonal contraception? Select all that apply. a) Reduced risk of ovarian cancer b) Decreased risk of anemia c) Decreased risk of gallbladder disease d) Reduced incidence of benign breast disease e) Improved acne control

• Improved acne control • Decreased risk of anemia • Reduced incidence of benign breast disease • Reduced risk of ovarian cancer Benefits of combined hormonal contraceptive use include reduced incidence of benign breast disease, improved acne, and reduced risk of uterine and ovarian cancers, anemia, and pelvic infection. Use, however, increases risk of gallbladder problems.

A nurse who will be working at a health fair is preparing a presentation on reproductive health and contraception. Which of the following would the nurse expect to include as advantages of combined hormonal contraception? Select all that apply. a) Decreased risk of anemia b) Reduced risk of ovarian cancer c) Reduced incidence of benign breast disease d) Decreased risk of gallbladder disease e) Improved acne control

• Reduced incidence of benign breast disease • Improved acne control • Reduced risk of ovarian cancer • Decreased risk of anemia Benefits of combined hormonal contraceptive use include reduced incidence of benign breast disease, improved acne, and reduced risk of uterine and ovarian cancers, anemia, and pelvic infection. Use, however, increases risk of gallbladder problems.

A client has obtained levonorgestrel as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which statement? a) "My boyfriend can buy levonorgestrel from the pharmacy if he is over 18 years old." b) "I may feel nauseated and have breast tenderness or a headache after using the contraceptive." c) "I can wait up to 4 days after intercourse to start taking these to prevent pregnancy." d) "The birth control works by preventing ovulation or fertilization of the egg."

"I can wait up to 4 days after intercourse to start taking these to prevent pregnancy." Levonorgestrel can reduce the chance of pregnancy if taken within 72 hours of unprotected intercourse, but pills are most effective if taken immediately after unprotected intercourse and then again 12 hours later,. Males can purchase this contraceptive as long as they are over 18 years of age. Levonorgestrel works by preventing ovulation or fertilization depending on where a client is the menstrual cycle. Common side effects include nausea, breast tenderness, vertigo, and stomach pain.

The nurse is evaluating a female client's understanding of how to prevent sexually transmitted infections (STIs). Which statement indicates that the client understands how to protect herself? a) "I will be sure to take antibiotics to prevent an STI." b) "I will be sure my partner uses a condom." c) "I need to be sure to take my birth control pills." d) "I will always douche after sexual intercourse."

"I will be sure my partner uses a condom." Barrier contraceptives must be used to protect against STIs. Birth control pills and douching are not effective for prevention of STIs. Prophylactic antibiotics are not used to prevent the acquisition of STIs

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which client statement indicates a need for further teaching? a) "If I gain or lose 20 lb (9 kg), I can still use the same diaphragm." b) "If I get pregnant, I will have to be refitted for another diaphragm after childbirth." c) "Before inserting the diaphragm I should coat the rim with contraceptive jelly." d) "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case."

"If I gain or lose 20 lb (9 kg), I can still use the same diaphragm." The client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 lb (9 kg). Gaining or losing more than 15 lb (7 kg) 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 childbirth 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.

A 22-year-old single female is discussing contraceptive methods with her health care provider and specifically asking about the ethinyl estradiol and etonogestrel vaginal insert. The nurse realizes the client needs further instruction when she makes which statement? a) "This ring contains only progesterone for birth control." b) "There is less breakthrough bleeding than with pills." c) "The risks are the same for this and combined pills." d) "If the ring falls out, it must be put back in place within 3 hours."

"This ring contains only progesterone for birth control." The vaginal ring contains a combination of estrogen and progesterone inserted into the vagina for 3 weeks, removed for 1 week, followed by reinsertion of a new ring. If the ring is out of place more than 3 hours contraceptive effectiveness decreases. A positive benefit of this form of contraception is a lessening of breakthrough bleeding often seen in other contraceptive methods. The risks associated with the ring are the same as experienced by someone using the combined estrogen/progesterone pills.

A client taking oral contraceptives is placed on a 10-day course of antibiotics for an infection. Which instruction should the nurse include in the teaching plan? a) "Call your health care provider for increased hunger or fluid retention." b) "Use a barrier method of birth control for the rest of your cycle." c) "Take the antibiotics 2 hours after the oral contraceptive." d) "You should stop taking the oral contraceptives while taking the antibiotic."

"Use a barrier method of birth control for the rest of your cycle." Antibiotics may decrease the effectiveness of oral contraceptives. The client should be instructed to continue the contraceptives and use a barrier method as a backup method of birth control until the next menstrual cycle. The client should not stop taking her oral contraceptives, and there is no indication for or benefit to taking the antibiotic 2 hours after the contraceptive. There is no incidence of the adverse effects of increased hunger and fluid retention with the interaction of antibiotic therapy and oral contraceptives.

The nurse is assessing a female patient who states that she notices an involuntary loss of urine following a coughing episode. What would be the nurse's best reply? a) "You are experiencing total incontinence. Have you had any surgeries or trauma that may be causing this?" b) "You are experiencing stress incontinence. Do you know how to do Kegel exercises?" c) "You are experiencing transient incontinence. Have you been administered diuretics or IV fluids lately?" d) "You are experiencing reflex incontinence. Have you had a spinal cord injury in the past?"

"You are experiencing stress incontinence. Do you know how to do Kegel exercises?" Pelvic floor muscle training (PFMT) can improve voluntary control of urination and significantly reduce or eliminate problems with stress incontinence (involuntary loss of urine related to an increase in intra-abdominal pressure) by strengthening perineal and abdominal muscle tone (Huebner et al., 2011). PFMT, more commonly called Kegel exercises, targets the inner muscles that lie under and support the bladder. These muscles can be toned, strengthened, and actually made larger by a regular routine of tightening and relaxing. Transient incontinence appears suddenly and lasts for 6 months or less. It is usually caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment, such as the use of diuretics or intravenous fluid administration. Stress incontinence (discussed earlier in the chapter) occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. This commonly occurs during coughing, sneezing, laughing, or other physical activities. Childbirth, menopause, obesity, or straining from chronic constipation can also result in urine loss. Total incontinence is a continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation. Urination cannot be controlled due to an anatomic abnormality.

Which example best supports the diagnosis of Sexual Dysfunction: Dyspareunia? a) A 39-year-old alcoholic woman is no longer interested in having sex with her partner. b) A 50-year-old woman in the process of menopause has pain and burning during intercourse. c) A patient with a colostomy believes she cannot have a sexual relationship with her husband because he will be repulsed by her stoma. d) A 50-year-old woman with a history of stroke is afraid to have sex with her partner for fear it will elevate her blood pressure.

A 50-year-old woman in the process of menopause has pain and burning during intercourse. Dyspareunia refers to pain and burning during intercourse. This is a common cause of sexual dysfunction, especially during menopause. A colostomy, fear of blood pressure elevation, and lack of interest in sex may lead to the nursing diagnosis of Sexual Dysfunction, but not related to dyspareunia.

A client is admitted to the facility with a suspected ectopic pregnancy. When reviewing the client's health history for risk factors for this abnormal condition, the nurse expects to find: a) grand multiparity (five or more births). b) use of a hormonal contraceptive for 5 years. c) a history of pelvic inflammatory disease. d) use of an intrauterine device for 1 year.

A history of pelvic inflammatory disease. Pelvic inflammatory disease with accompanying salpingitis is commonly implicated in cases of tubal obstruction, the primary cause of ectopic pregnancy. Ectopic pregnancy isn't associated with grand multiparity or hormonal contraceptive use. Ectopic pregnancy is associated with use of an intrauterine device for 2 years or more.

During the home visit, a breastfeeding client asks the nurse what contraception method she and her partner should use until she has her 6-week postpartal examination. Which method would be most appropriate for the nurse to suggest? a) abstinence b) condom with spermicide c) rhythm method d) oral contraceptives

Condom with spermicide If not contraindicated for moral, cultural, or religious reasons, a condom with spermicide is commonly recommended for contraception after birth until the client's 6-week postpartal examination. This method has no effect on the neonate who is breastfeeding. Oral contraceptives containing estrogen are not advised for women who are breastfeeding because the hormones decrease the production of breast milk. Women who are not breastfeeding may use oral contraceptive agents. The rhythm method is not effective because the client is unlikely to be able to determine when ovulation has occurred until her menstrual cycle returns. Although breastfeeding is not considered an effective form of contraception, breastfeeding usually delays the return of both ovulation and menstruation. The length of the delay varies with the duration of lactation and the frequency of breastfeeding. While abstinence is one form of birth control and safe while breastfeeding, it may not be acceptable to this couple who is asking about a method that will allow them to resume sexual relations.

A nurse is caring for a female client before surgery. The client states that she is glad that she will not be going through menopause as a result of her surgery and is only having her uterus removed. The nurse reviews the consent form and notes that the surgery is for a total abdominal hysterectomy with a salpingo-oophorectomy. What should the nurse do in this situation? a) Place a note on the front of the chart informing the surgeon to speak with the client before surgery. b) Contact the surgeon and inform him/her that the client needs further clarification regarding surgery. c) Inform the client that menopause may occur from the removal of the uterus. d) No action is needed because the client is likely correct and knows what the surgery entails.

Contact the surgeon and inform him/her that the client needs further clarification regarding surgery. The nurse should call the surgeon to clarify the extent of the surgery with the client and what is to be expected after surgery. The nurse acts as an advocate for the client. The other options do not demonstrate the nurse's understanding of the responsibility when obtaining consent. It is not the nurse's responsibility to explain the surgery to the client. Placing a note on the front of the chart is not acting in the best interest of the client because the note may get lost.

A client takes a hormonal contraceptive to prevent pregnancy. The nurse should instruct her to use an alternative contraceptive method when receiving which drug concomitantly? a) Cyclosporine b) Erythromycin c) Primidone d) Hydrocortisone

Primidone Primidone, an anticonvulsant, may decrease the efficacy of hormonal contraceptives, necessitating use of an alternative contraceptive method. Concomitant use of hormonal contraceptives with cyclosporine increases the plasma concentration of cyclosporine. No interaction occurs between erythromycin and hormonal contraceptives. Hormonal contraceptives enhance the anti-inflammatory actions of hydrocortisone.

A 55-year-old patient has hypertension. She has admitted to her physician that she stopped taking her regular medications about 3 months ago and started an alternative, new-age therapy. When the patient asks about herbal remedies to treat her hot flashes, which of the following natural estrogens is the physician likely to recommend? a) Soy milk b) Turmeric powder c) Bitter gourd tea d) Ginkgo biloba

Soy milk Alternative treatments like natural estrogens found in soy products may be effective in treating hot flashes associated with menopause. Ginkgo biloba is an herbal remedy that may help to treat blood disorders and improve memory. The benefits of drinking bitter gourd tea include possible blood sugar regulation, cancer prevention, and antioxidant protection. Turmeric is used in the treatment of digestive and liver problems.

The nurse educator is presenting a lecture on clients at risk for developing urinary tract infections (UTIs). Which response made by the staff nurse would indicate to the educator a need for further teaching? a) "I will make sure to teach my clients with diabetes mellitus to control their glucose level to help prevent an UTI." b) "A woman using an intrauterine device for contraceptive reason is at risk for developing an UTI." c) "Having sexual relationships does not put a woman at risk for developing an UTI." d) "Due to the physiological changes with aging, the elderly are at risk for developing an UTI."

"Having sexual relationships does not put a woman at risk for developing an UTI." During sexual intercourse, bacteria from the perineal area may travel into the urethra and urinary bladder. The spermicide used with the diaphragm (IUD) decreases the vagina?s normally protective flora. The glucose in the urine acts an excellent medium for bacteria to proliferate in the client with diabetes mellitus. The elderly are predisposed to development of UTI due to the physiological changes associated with aging.

The nurse prepares to counsel a 28 year old female who is presenting to the infertility clinic for her first appointment. The nurse knows to include which of the following in the assessment? a) History of an untreated sexually transmitted infection (STI) b) Recent untreated urinary tract infection (UTI) c) Current and previously used contraceptive methods d) Age at onset of menses

History of an untreated sexually transmitted infection (STI) Health problems caused by STIs tend to be more severe and more frequent for women than for men, in part because the frequency of asymptomatic infection means that many women do not seek care until serious problems have developed.Some STIs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. While it is important to note the current and previously used contraceptive methods used it is unlikely the cause for the client's infertility. The age at onset of menses is important to note for the client's overall health history however, it is not a cause of infertility. An untreated UTI will not lead to infertility.

A nulligravid client calls the clinic and tells the nurse that she forgot to take her oral contraceptive this morning. The nurse should tell the client to: a) restart the medication in the morning. b) take the medication immediately. c) use another form of contraception for 2 weeks. d) take two pills tonight before bedtime.

Take the medication immediately. The nurse should instruct the client to take the medication immediately or as soon as she remembers that she missed the medication. There is only a slight risk that the client will become pregnant when only one pill has been missed, so there is no need to use another form of contraception. However, if the client wishes to increase the chances of not getting pregnant, a condom can be used by the male partner. The client should not omit the missed pill and then restart the medication in the morning because there is a possibility that ovulation can occur, after which intercourse could result in pregnancy. Taking two pills is not necessary and also will result in putting the client off her schedule.

A 25-year-old sales manager with a financial firm reports to the health care unit with high stress levels and a BP reading of 130/80 mm Hg. She admits that her life has been stressful as she is unable to meet sales targets and is going through a financial crisis. She suffers from frequent headaches and blurred vision. She currently uses a cervical ring for contraception. Which of the following additional assessment questions related to the patient's choice of contraception does the nurse need to ask? Select all that apply. a) "Describe any abdominal pain you may be experiencing." b) "Have you noticed any episodes of chest pain?" c) "When was your last self-breast exam?" d) "Tell me about the last time you had leg pain." e) "When was your last bowel movement?"

• "Tell me about the last time you had leg pain." • "Describe any abdominal pain you may be experiencing." • "Have you noticed any episodes of chest pain?" Using the American College of Healthcare Executives (ACHE) assessment for patients using combination contraceptives, the nurse needs to assess for abdominal pain, chest pains, and severe leg pains. Last bowel movement and self-breast exam are to be included in the patient's assessment, but do not directly relate to the assessment of the patient's method of contraception.

A nurse considers the culture of an Appalachian female patient when counseling her about contraceptives. Which beliefs are consistent with this culture? (Select all that apply.) a) Youth is valued over age. b) Feelings about losses or death may be fatalistic. c) Isolation is an accepted way of life. d) Independence and self-determination are valued. e) Illness is considered a punishment from God. f) Belief is in a divine existence rather than attending a particular church.

• Belief is in a divine existence rather than attending a particular church. • Isolation is an accepted way of life. • Feelings about losses or death may be fatalistic. • Independence and self-determination are valued. Within the Appalachian community the following beliefs are predominately found: isolation is an accepted way of life, feelings about losses or death may be fatalistic, and independence and self-determination are valued. It can also be commonly seen that the Appalachian culture has a belief in a divine existence rather than attending a particular church. The other statements listed are not found to be true within this community.

A client presents to the clinic seeking the safest contraceptive method for her. The nurse reviews the client's health history and notes that the client is 26 years old, married with no children, and a smoker. Based on the client's history the nurse knows the following methods are the most appropriate for this client. (Select All That Apply) a) Implanon b) Norplant System c) Transdermal Contraceptive Patch d) Depo-Provera e) Oral Contraceptives

• Norplant System • Implanon • Depo-Provera According to the client's history she is a smoker. Smoking increases the risks associated with oral contraceptives. The transdermal contraceptive patch has the same contraindications as oral contraceptives. All of the other options are not contraindicated based on the client's history.

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2 inches (1.7 m) tall." Which statement is the best response by the nurse? a) "There may be some slight discrepancy between the measuring tools used." b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." c) "After age 40, height may show a gradual decrease as a result of spinal compression" d) "The posture begins to stoop after middle age."

"After menopause, the body's bone density declines, resulting in a gradual loss of height." The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

A nurse is providing teaching to a client who's being discharged after delivering a hydatidiform mole. Which expected outcome takes highest priority for this client? a) "Client will schedule her first follow-up Papanicolaou (Pap) test and gynecologic examination for 6 months after discharge." b) "Client will state that she won't attempt another pregnancy until her human chorionic gonadotropin (hCG) level rises." c) "Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative." d) "Client will state that she may attempt another pregnancy after 3 months of follow-up care."

"Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative." After a molar pregnancy, the client should receive follow-up care, including regular hCG testing, for 1 year because of the risk of developing chorionic carcinoma. After removal of a hydatidiform mole, the hCG level gradually falls to a negative reading unless chorionic carcinoma is developing, in which case the hCG level rises. A Pap test isn't an effective indicator of a hydatidiform mole. A follow-up examination would be scheduled within weeks of the client's discharge. The client must not become pregnant during follow-up care because pregnancy causes the hCG level to rise, making it indistinguishable from this early sign of chorionic carcinoma.

The nurse is teaching a young woman about using oxcarbazepine to control seizures. The nurse determines teaching is effective when the client states: a) "I must weigh myself weekly to check for sudden gain in weight." b) "I will use one of the barrier methods of contraception." c) "Since I am 28 years old, I should not delay starting a family." d) "I will need a higher dose of oral contraceptive when on this drug."

"I will use one of the barrier methods of contraception." An alternative or additional method of birth control must be used because oxcarbazepine reduces the effectiveness of oral contraceptives. Higher doses of oral contraceptives will not help in achieving this purpose, but the client needs an additional or alternative method of birth control. The client does not need advice about when to start a family. A side effect of oxcarbazepine may be weight gain, but it is typically gradual.

Which client statement indicates that the nurse's teaching about oral contraceptive agents has been successful? a) "I can make these drugs more effective by monitoring my basal body temperature." b) "If I forget to take my pill one day, I can take 2 pills to get back on schedule" c) "Oral contraceptives help prevent pregnancy by changing the cervical mucus." d) "These agents usually only cause a few minor adverse effects when you take them."

"If I forget to take my pill one day, I can take 2 pills to get back on schedule" If a client forgets to take her oral contraceptive pill, she should take the pill as soon as she remembers. If a whole day has passed, it is okay to take 2 pills on one day to get back on schedule. Oral contraceptive agents may cause numerous and often bothersome or dangerous adverse effects including nausea, vomiting, fluid retention, increased vaginal discharge, chloasma, headaches, weight gain, thromboembolic disorders, hepatic adenoma, and possible hypertension. A history of thromboembolic disease is an absolute contraindication to using oral contraceptive agents. Oral contraceptive agents inhibit ovulation by suppressing follicle-stimulating hormone and luteinizing hormone. They have no effect on cervical mucus. It is not necessary to monitor basal body temperature because ovulation does not occur when the medication is taken properly.

After discussing the various methods of contraception with a nurse, a client decides on the contraceptive sponge as her method of choice. Which of the following would the nurse include in the teaching plan for the client about this contraceptive method? a) "You need to have the sponge fitted before using it." b) "Keep the sponge in place for at least 6 hours after intercourse." c) "Clean the sponge with mild soap and water after using it." d) "You can use this at any time, even when you are menstruating."

"Keep the sponge in place for at least 6 hours after intercourse." The contraceptive sponge is left in place in the vagina for at least 6 hours after intercourse, and can be kept in place for up to 24 additional hours without the need to replace it with repeated acts of intercourse during that period of time. The sponge should not be used during menstruation. The sponge is available without a prescription, does not need to be fitted, and is discarded after use. The diaphragm and cervical cap need to be fitted before they are used. Mild soap and water are used to clean a diaphragm after use.

A nurse is preparing to obtain a sexual history from a client using the PLISSIT model. Which question would be most appropriate for the nurse to ask first? a) "May I ask you some questions about your sexual health?" b) "How long have you been sexually active?" c) "Have you ever used any contraceptive measures?" d) "Are you currently having sex, and if yes, with whom?"

"May I ask you some questions about your sexual health?" The PLISSIT model prvides a framework for nursing interventions. The assessment begins by introducing the topic and asking the client for permission to discuss issues related to sexuality with her. Therefore, the nurse would ask the client if it would be okay to ask her some questions about her sexual health. The history continues by inquiring about present sexual activity and sexual orientation as well as any problems or concerns that the client may be having. Asking about how long the client has been sexually active, about the use of contraception, and current sexual activity level would be appropriate once the nurse has established a trusting relationship with the client and obtained permission. The nurse would need to maintain a nonjudgmental approach and respect the client's wishes if she does not want to discuss a topic or issue.

A 48-year-old client with challenging menopausal symptoms is visiting the OB-GYN practice where you practice nursing. She has discussed treatment options with the physician and now has some questions that she would like to further discuss with you. The client includes in her questioning, "What are the potential risks of hormone replacement therapy?" Which of the following is the best answer? a) Breast cancer b) Stroke (CVA) c) All options are correct. d) Heart disease

All options are correct. In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in blood clots and stroke in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in heart disease in postmenopausal women taking HRT.

A nurse is teaching a client about hormonal contraceptive therapy. If a client misses three or more pills in a row, the nurse should instruct the client to: a) discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule. b) take two pills for the next 2 days and use an alternative contraceptive method until the next cycle. c) take all the missed doses as soon as she discovers the oversight. d) take three pills for the next 3 days and use an alternative contraceptive method until the next cycle.

Discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule. A client who misses three or more pills in a row should discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule. Taking all the missed doses, taking two pills for the next 2 days, or taking three pills for the next 3 days doesn't ensure effectiveness and can increase the risk of adverse reactions.

A nurse is preparing to provide contraceptive counseling for a client. What should the nurse plan to do first? a) Help determine the most appropriate contraceptive method for the client. b) Explore her own personal beliefs and feelings about contraception. c) Obtain a thorough health history from the client. d) Perform a complete physical assessment of the client.

Explore her own personal beliefs and feelings about contraception. The nurse must first explore her own personal beliefs and feelings about contraception to detect biases; if biases exist, the nurse must refer the client to another health care professional. Only after exploring personal beliefs and feelings does the nurse obtain a thorough health history, perform a complete physical assessment, and help determine the most appropriate contraceptive method.

A primiparous nonbreastfeeding client at 48 hours postpartum is to be given medroxyprogesterone before discharge. What information should the nurse include in the teaching plan before administering this medication? a) There is an increased risk of ovarian cancer with use of this drug. b) The client may experience periods of increased energy. c) Heavy menstrual bleeding may occur. d) Amenorrhea is common during the first 6 months.

Heavy menstrual bleeding may occur. As with other contraceptives that are progestin based, heavy menstrual bleeding may occur. Other adverse effects include rash, acne, alopecia, fluid retention, edema, and sudden loss of vision. Depression and weight gain have been reported. For clients taking this drug, the risk of endometrial or ovarian cancer is decreased. Amenorrhea has been reported in clients after receiving four injections 3 months apart for 1 year. Depression and loss of energy have been reported.

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for which signs and symptoms? a) acne vulgaris b) dysmenorrhea c) anemia d) hypertension

Hypertension 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 commonly improves facial acne.

Which action should the nurse be sure is included in the education plan of a newly married female client with a cervical spinal cord injury who doesn't wish to become pregnant at this time? a) Instruct the client on the rhythm method of contraception b) Instruct the client's husband on proper insertion of a diaphragm with contraceptive jelly c) Provide the client with brochures on sexual practice d) Provide the client's husband with information on vasectomy

Instruct the client's husband on proper insertion of a diaphragm with contraceptive jelly Because the client experienced a cervical spinal cord injury, she can't insert any form of contraception protection; therefore, it's vital to provide her husband with instructions on inserting a diaphragm in order to prevent pregnancy. Providing the couple with literature on sexual practice doesn't address the client's concerns. During this time of crisis, the couple doesn't wish to have children, but they may reconsider, so providing information on vasectomy isn't appropriate. The rhythm method isn't the most effective way to prevent pregnancy.

A 23 year old female presents with the following symptoms: bleeding, feeling sad, headaches, increased acne, and recent weight changes. The nurse knows that the following need to be reviewed with the patient. a) Use of oral contraceptives in the past month b) Intrauterine device(IUD) placement within past 3 months c) Hormone imbalance caused by pregnancy d) Pregnancy related risk factors

Intrauterine device(IUD) placement within past 3 months With intrauterine devices the clinician should be aware that adverse side effects peak at 3 months of use and reduce in frequency after that. The most common side effects include bleeding, depression, headache, acne, and weight changes. While some of the symptoms are found as side effects of oral contraceptive use and as signs of pregnancy the age of the client and cluster of symptoms should alert the nurse to assess for the presence of an IUD.

When planning sex education and contraceptive education for adolescents, which factor should the nurse consider? a) Most teenagers are open about contraception but inconsistently use birth control b) Neither sexual activity nor contraception requires planning c) Most teenagers today are knowledgeable about reproduction d) Most teenagers use pregnancy as a way to rebel against their parents

Most teenagers are open about contraception but inconsistently use birth control Most teenagers today are very open about discussing contraception and sexuality, but they may get caught up in the moment of sexuality and forget about birth control measures. Adolescents receive most of their information on reproduction and sexuality from their peers, who generally don't have correct information. Teenagers generally become pregnant because they fail to use birth control for reasons other than rebelling against their parents. Contraception should always be part of sex education and requires planning.

After instructing a 20-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? a) nausea b) headache c) ovarian cancer d) weight gain

Ovarian cancer The nurse determines that the client needs further instruction when the client says that one of the adverse effects 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.

A 32-year-old female client visits the family planning clinic and requests an intrauterine device for contraception. When assessing the client, a history of which problem would be most important to determine? a) thrombophlebitis b) coronary artery disease c) previous liver disease d) pelvic inflammatory disease

Pelvic inflammatory disease The nurse should assess the client for a history of pelvic inflammatory disease because intrauterine devices have been associated with an increased risk of pelvic inflammatory disease and perforation of the uterus. A history of thrombophlebitis, liver disease, or cardiovascular disease would be important to assess if the client were to receive oral contraceptives. Thrombophlebitis is a contraindication for oral contraceptives.

A nurse is providing care to a client who was just admitted with a diagnosis of ectopic pregnancy. When reviewing the client's history, which of the following would the nurse identify as a major risk factor for this client? a) Combined hormonal contraceptive use b) Habitual abortions c) Pelvic inflammatory disease (PID) d) Use of in vitro fertilization

Pelvic inflammatory disease (PID) PID is a major risk factor for ectopic pregnancy. Other risk factors include salpingitis, peritubal ahdesions, structural abnormalities of the tube, previous ectopic pregnancy, previous tubal surgery, multiple previous induced abortions, tumors that distort the tube, and IUD and progestin-only contraceptives. Combined hormonal contraceptive use, in vitro fertilization, and habitual abortions are not risk factors for ectopic pregnancy.

Which instructions should the nurse 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 adverse effect of IUDs. b) Severe cramping may occur when the IUD is inserted. c) The client needs to use additional protection for conception. d) IUDs are more costly than other forms of contraception.

Severe cramping may occur when the IUD is inserted. 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 adverse 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.

The nurse tells a rape victim that even if she was protected against pregnancy by a contraceptive and has no intention of taking any legal action against her assailant, she should still be checked by a health care provider (HCP) for early detection of: a) anxiety reaction. b) menstrual difficulties. c) periurethral tears. d) sexually transmitted disease.

Sexually transmitted disease. The post-rape examination is important for detecting the possibility of sexually transmitted disease, which can be spread through rape. The client should also be examined for infection that can result from trauma. Additionally, if the victim or the rapist was not using a contraceptive, postcoital contraceptive methods should be discussed. The information provided does not indicate anxiety or physical injury, such as periurethral tears, and these are not the primary reason for the examination. Menstrual difficulties are not a common result of rape.

A client believes she is experiencing premenstrual syndrome (PMS). The nurse should next ask the client about what symptom? a) menstrual cycle irregularity with increased menstrual flow b) tension and fatigue before menses and through the second day of the menstrual cycle c) mood swings immediately after menses d) midcycle spotting and abdominal pain at the time of ovulation

Tension and fatigue before menses and through the second day of the menstrual cycle The timing of symptoms is important to the diagnosis of PMS. The client should keep a 3-month log of symptoms and menses. With PMS, the symptoms begin 3 to 7 days before menses and resolve 1 to 2 days after the menstrual cycle has started. Menstrual cycle irregularity and mood swings after menses are not related to PMS, and other causes should be investigated. Midcycle spotting and pain are related to ovulation.

A client with ovarian cancer asks the nurse, "What is the cause of this cancer?" Which is the most accurate response by the nurse? a) Use of oral contraceptives increases the risk of ovarian cancer. b) Women who have had at least two live births are protected from ovarian cancer. c) The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. d) There is less chance of developing ovarian cancer when one lives in an industrialized country.

The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. A definitive cause of carcinoma of the ovary is unknown, and the disease is multifactorial. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. The highest incidence is in industrialized Western countries. Endocrine risk factors for ovarian cancer include women who are nulliparous. Use of oral contraceptives does not increase the risk for developing ovarian cancer, but may actually be protective.

The nurse knows that there are three basic charting methods in predicting ovulation in order to prevent pregnancy. (Select All That Apply) a) Temperature method b) Hormonal method c) Cervical mucus method d) Calendar method

• Calendar method • Cervical mucus method • Temperature method Three basic charting methods can be used to predict ovulation in order to plan or prevent pregnancy:temperature, cervical mucus, and calendar method.The best approach to monitoring fertility is a combination of all three methods called the symptothermal method. Hormonal methods are based on the feedback mechanism of hormones of the menstrual cycle used as a contraceptive method not a charting method.

A client is diagnosed with osteoporosis. Which statements would the nurse include when teaching the client about the disease? Select all that apply. a) Passive ROM exercises can promote bone growth. b) Osteoporosis is common in females after menopause. c) Osteoporosis can cause pain and injury. d) Weight-bearing exercise would be avoided. e) Osteoporosis is a degenerative disease characterized by a decrease in bone density. f) The disease is inherited, caused by an inability to tolerate milk products.

• Osteoporosis is common in females after menopause. • Osteoporosis is a degenerative disease characterized by a decrease in bone density. • Osteoporosis can cause pain and injury. Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen. The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth.

A 27-year-old patient is a regular smoker and is diabetic. She is requesting contraceptive therapy. She has been diagnosed with hypertension. She says she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure. Her vital signs are temperature 98.8°F, pulse 72, respirations 12, BP 112/72 mm Hg. In addition, laboratory reports show a hemoglobin A1C level of 5%. Which of the following aspects of patient teaching would the nurse recommend? Select all that apply. a) Discussing methods for stress reduction b) Administering glycemic control c) Prescribing a combination oral contraceptive pill d) Purchasing a self-monitoring cuff e) Advising a smoking cessation program

• Purchasing a self-monitoring cuff • Discussing methods for stress reduction • Advising a smoking cessation program • Prescribing a combination oral contraceptive pill Because this patient finds it time consuming to visit the doctor just for a BP reading, the nurse can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods for stress reduction and advising a smoking cessation would constitute patient education in managing hypertension. Controlled hypertension in otherwise healthy young nonsmokers is generally not a contraindication to use of combination agents, but does require a low dose and careful BP monitoring. Hemoglobin A1C levels are within acceptable levels; administering glycemic control is not indicated at this time.

The nurse is counseling a young rape victim in the emergency department and recommends emergency contraception. Which statements describe this process? (Select all that apply.) a) The physician will prescribe increased doses of oral contraceptives. b) A vaginal sponge will be prescribed to be worn daily for seven days. c) Plan B One-Step may be obtained without a prescription at a drugstore or family planning clinic d) The physician will order a copper IUD within 5 to 7 days of the unprotected sex. e) A vaginal ring will be inserted within 36 hours of unprotected sex. f) An emergency D&C;will be performed within 24 hours of unprotected sex.

• The physician will prescribe increased doses of oral contraceptives. • The physician will order a copper IUD within 5 to 7 days of the unprotected sex. • Plan B One-Step may be obtained without a prescription at a drugstore or family planning clinic Increased doses of some oral contraceptives can reduce the risk of pregnancy when taken up to 120 hours after unprotected intercourse (ideally within 72 hours) by 89%. Copper IUDs can help in emergency contraception. Plan B One-Step is an over-the-counter emergency contraceptive. A vaginal sponge and a vaginal ring are contraceptive devices used to prevent pregnancy prior to intercourse; they are not effective if used after intercourse has occurred. Dilation and curettage (D&C;) is a surgical procedure that scrapes the uterine lining. It is not use for emergency contraception.

The nurse is assessing a multigravid client at 12 weeks' gestation who has been admitted to the emergency department with sharp right-sided abdominal pain and vaginal spotting. Which information should the nurse obtain about the client's history? Select all that apply. a) number of sexual partners b) history of sexually transmitted infections c) contraceptive use d) cesarean section e) last menstrual period

• history of sexually transmitted infections • number of sexual partners • last menstrual period • contraceptive use The client may be experiencing an ectopic pregnancy. Contributing factors to an ectopic pregnancy include a prior history of sexually transmitted infection that can scar the fallopian tubes. Multiple sex partners increase the risk of sexually transmitted infections. Knowledge of the client's last menstrual period and contraceptive use may support or rule out the possibility of an ectopic pregnancy. The client's history of cesarean sections would not contribute information valuable to the client's current situation or potential diagnosis of ectopic pregnancy.

A woman is using progestin injections for contraception. The nurse instructs the client to return for an appointment in: a) 6 months. b) 1 month. c) 3 months. d) 4 months.

3 months. At the time a client receives a progestin injection, a follow-up appointment should be made for 3 months later. The nurse should emphasize the need to adhere to the medication schedule to prevent an unplanned pregnancy. One of the most common reasons for failure of this contraceptive is lack of adherence to the appointment schedule for injections every 3 months.

Which of the following patients in the ED should the advance nurse practitioner treat first? a) A 32-year-old woman with bloating, headache, and reported depression b) A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness c) A 19-year-old woman with vaginal irritation, malodorous, copious frothy/yellow-green discharge d) A 48-year-old woman presenting with irregular menses, breast tenderness, and profuse sweating

A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness The patient with sharp colicky abdominal pain, menstrual spotting, and dizziness has clinical manifestations of an ectopic pregnancy and should be treated first. If untreated, a ruptured ectopic pregnancy can be life threatening. Bloating, headache, and depression are consistent with premenstrual syndrome (PMS) and do not indicate the priority patient at this time. Irregular menses, breast tenderness, and sweating are expected premenopausal symptoms. Vaginal irritation, malodorous copious frothy/yellow-green discharge is consistent with a Trichomonas species infection and is not the priority patient.

When developing a teaching plan for a client taking hormonal contraceptives, a nurse should ensure that the client knows she must have which vital sign monitored regularly? a) Pulse b) Blood pressure c) Respirations d) Temperature

Blood pressure The incidence of hypertension is three to six times greater in clients using hormonal contraceptives than in women who don't use these drugs. Age and duration of the drug's use increase this incidence. Hormonal contraceptives don't directly affect pulse, respirations, or temperature.

A nulliparous client has been given a prescription for oral contraceptives. The nurse should instruct the client to report which sign to the health care provider (HCP) immediately? a) nausea b) weight gain c) mild headache d) blurred vision

Blurred vision Blurred vision is a serious adverse effect of oral contraceptives, possibly because of severe hypertension as a result of the medication. If the client experiences blurred vision, she needs to contact her HCP immediately. Nausea, weight gain, and mild headache are common and possibly bothersome side effects and should be noted. However, they do not need to be reported immediately unless they are severe, prolonged, or accompanied by other symptoms.

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) preference of sexual partner c) satisfaction with prior methods d) desire for another child in 2 years

Breast- or bottle-feeding plan 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 exception. Use of estrogen-/progesterone-based pills and progesterone-only 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 breast-feed.

To help prevent osteoporosis, what should a nurse advise a young woman to do? a) Avoid trauma to the affected bone. b) Consume at least 1,000 mg of calcium daily. c) Encourage the use of a firm mattress. d) Keep the serum uric acid level within the normal range.

Consume at least 1,000 mg of calcium daily. To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it's 1,500 mg. Because osteoporosis affects all bones, avoiding trauma to the affected bone only is inappropriate. Using a firm mattress and keeping the uric acid level within the normal range don't relate to osteoporosis. The nurse should encourage a client with ankylosing spondylitis to sleep on a firm mattress. The nurse should advise a client with gouty arthritis to keep the serum uric acid level in the normal range.

The nurse interviews a 22-year-old female client who is scheduled for abdominal surgery the following week. The client is obese and uses estrogen-based oral contraceptives. This client is at high risk for development of: a) atherosclerosis. b) thrombophlebitis. c) diabetes. d) Raynaud's disease.

Thrombophlebitis. The data suggest an increased risk of thrombophlebitis. The risk factors in this situation include abdominal surgery, obesity, and use of estrogen-based oral contraceptives. Risk factors for atherosclerosis include genetics, older age, and a high-cholesterol diet. Risk factors for diabetes include genetics and obesity. Risk factors for vasospastic disorders include cold climate, age (16 to 40), and immunologic disorders.