MCN LEC MIDTERMS

before

A condom must be applied ______________ any penile-vulvar contact

a healthcare provider

A diaphragm has traditionally been prescribed and fit initially by ______________

vagina, anterior rim, vaginally

A diaphragm is removed by inserting a finger into the _______________ and loosening the diaphragm by pressing against the _________________ then withdrawing it ____________________

6 hours

A diaphragm should remain in place for at least ________ after coitus

2 years

A diaphragm will last for _________________________________, after which it should be replaced

refitting of diaphragm or cap

Adolescents need ____________________ more often since their vagina changes with growth

some spotting or uterine cramping

After 2 to 3 weeks of IUD insertion, what can the patient expect to happen?

3 days

After medical abortion, a patient can resume regular activities but avoid heavy lifting or strenous exercise for about ____________________

copious, 3-4 days

All the days on which cervical mucus is ________________, and for at least ________________________ afterwards, are considered to be fertile days

negative sperm reports, 6, 10

An additional birth control should be used until _________________________________________________ at about _________ and _________ weeks have been obtained

Safe Effective Compatible with spiritual and cultural beliefs and personal preferences of both the user and sexual partner Free of bothersome effects Convenient to use and easily obtainable Affordable and needing few instructions for effective use Free of effects (after discontinuation) on future pregnancies

An ideal contraceptive should be

Postpartum people

Are good candidates for natural family planning since they can breastfeed without worrying about hormonal contamination or decrease in breast milk

No

Are natural family planning methods the usual contraceptive method that adolescents are using?

No

Are people aged 35 years old and older good candidates for COCs?

progesterone, 6 weeks

Because DMPA contains only __________________________ it can be used during breastfeeding, but patients should wait for about ______________________________ after birth for the first injection

Vital signs, pregnancy test, and perhaps hemoglobin for detection of anemia Pap smear and STI screening (with patient's permission) Obstetric history Subjective assessment of patient's desire, needs, feelings, and understanding of conception Sexual practices (frequency, number of partners, feelings about sex, and body image)

Before a patient begins using a new method of contraception, information that should be obtained includes:

thick and does not stretch

Before ovulation each month, the cervical mucus is __________________________________________________ when pulled between the thumb and finger.

increased sexual enjoyment

Both tubal ligation and vasectomy may lead to _______________________________________________________________

7, advise the patient to use a second form of contraception during the initial 7 days

COCs are not effective for the first ________ days, which is why you should _____________________________________

history of thromboembolic disease or a family history of cerebral or cardiovascular accident, who are over 40 years of age, or who smoke because of the increased tendency toward clotting as an effect of increased estrogen

COCs are not routinely prescribed for women with a

glucose metabolism

COCs can interfere with

No

Can you use female and male condoms together?

48 hours

Cervical cap can be kept in place for ___________________

pregnancy and undiagnosed uterine bleeding

Contradictions to subdermal rod

People with acute cervicitis

Contraindications for spermicide

if the uterus is prolapsed, retroflexed, or anteflexed to such a degree that the cervix is also displaced in relation to the vagina. Intrusion of a vagina by a cystocele or rectocele History of toxic shock syndrome (TSS; staphylococcal infection introduced through the vagina) • Allergy to rubber or spermicides • History of recurrent UTIs

Contraindications of Diaphragm

• An abnormally short or long cervix • A previous abnormal Pap smear • A history of TSS • An allergy to latex or spermicide • A history of pelvic inflammatory disease, cervicitis, or papillomavirus infection • A history of cervical cancer • An undiagnosed vaginal bleeding

Contraindications of cervical cap

allergy to latex, polyutherane, or natural membrane types

Contraindications to the use of condoms

12 weeks

DMPA is given every _____________________________

2 years, bone loss

DMPA should not be used for longer than _____________________ to protect against _______________________

6 hours, 24 hours

Diaphragms should remain in place for at least ______________ after coitus and they can be left in place for as long as ____________________

menstrual period

Do not use a diaphragm during a _________________________________

No

Does natural family planning methods have an effect on pregnant people?

LDL, HDL

Estrogen may lower ______ levels and increase ______ levels

25%

Failure rate of natural family planning methods

facial acne, dysmenorrhea

For adolescents, COCs have side benefits of improving __________________________ in some because of the increased estrogen/androgen ratio created and also decreasing ___________________________

1 hour

Gels or creams are easily inserted into the vagina before coitus with the provided applicator no more than ______ before coitus

Subtract 18 from the longest cycle documented (represents the first fertile day) and subtract 11 from the shortest cycle documented (represents the last fertile day).

How to do the calendar method?

distorted uterus shape

IUD is contraindicated for people with?

pelvic examination, a test for gonorrhea and chlamydia

IUDs are inserted by a healthcare provider who first performs _________________________________________________________________________________________________________

has had coitus

IUDs are usually inserted before a patient _________________

discontinue taking any more pills if she intends to continue the pregnancy

If a woman taking an estrogen/progestin combination COC suspects that she is pregnant she should do what?

6 hours

If the user chooses to douche to remove the spermicide afterward, they should wait ___________________ after coitus to ensure that the agent has completed its spermicidal action

No

If they desire temporary contraception, is it ideal for them to undergo tubal ligation or vasectomy?

Personal values Ability to use a method correctly If the method will affect sexual enjoyment Financial factors If a couple's relationship is short term or long term Prior experiences with contraception Future plans Expectations about menstrual cycle patterns while on birth control

Important things to consider when helping a patient or couple chooses a method

Carbon dioxide

In laparoscopy, __________________ is pumped into the incision to lift the abdominal wall upward and out of the line of vision

progesterone

It interferes with tubal transport and endometrial proliferation to such an extent the possibility of implantation is significantly decreased.

estrogen-based

It is recommended that lactating women should stay away from _____________________________ contraceptives

15

It takes _____ minutes for a suppository to dissolve

increases

Just before ovulation, mucus secretion ________________

The baby is: Under 6 months of age Being totally breastfed at least every 4 hours during the day and every 6 hrs at night Receive no supplementary findings Menses has not returned (mother)

LAM is a safe method when:

spermicide

Many adolescents use _____________________ as their chief method of birth control because no parental permission or extensive expense is involved

single, 70 days, 24 to 48 hours

Mifepristone is taken as a ___________________ dose anytime before ________________ gestational age followed in _______________________ by buccal, sublingual, or vaginal misoprostol , which causes uterine contractions

after an elective termination of pregnancy, or 6 weeks after the birth of a baby

Nexplanon can be placed immediately after ____________________________________ or ______________________________

during menses or no later than day 7 of a menstrual cycle

Nexplanon is inserted when?

4, ring-free week

NuvaRing can be replace after the ____ week cycle, while Annovera can be replaced after the __________

copious, thin, watery, and transparent

On the day of ovulation, mucus becomes _________________________________________________________________________

Mini-pills

Oral contraceptives containing only progestins are popularly called

natural estrogen, synthetic estrogen and synthetic progesterone (progestin)

Oral contraceptives, commonly known as the pill, OCs (for oral contraceptive), or COCs (for combination oral contraceptives), are composed of varying amounts of ____________________________________combined with a small amount of _____________________________________________

12 to 24 hours

Ovulation detection kits detect the midcycle surge of LH that can be detected in urine ________________ before ovulation.

upper outer arm, upper torso (front or back, excluding the breasts), abdomen, or buttocks

Patches may be applied to one of following four areas:

Sunday start: Take the first pill on the first Sunday after the beginning of a menstrual flow Quick start: Begin pills as soon as they are prescribed. First-day start: Begin pills on the first day of menses After child birth, a patient should start the contraceptive on a day closest to 2 weeks after birth or after an elective termination of pregnancy

Patients can set a start date for a cycle of pills in one of four ways:

2-3 days

Patients may return to having coitus as soon as __________________ after laparoscopy

They have gained or lost more than 15 lbs

Patients should also return for a second fitting of a diaphragm if

7 hours, replace the ring and use a form of barrier protection for the next 7 days

Patients should be counseled that if they should take out the ring for more than __________ of any purpose, they should ________________________________________________ and _________________________________________

They are pregnant, they had a miscarriage or a cervical surgery, or elective termination of pregnancy

Patients should return for a second fitting of a diaphragm if

COCs

Patients with recurrent convulsions (epilepsy) might be unable to take ______________ since estrogen interacts with common seizure medications

35, cystocele and rectocele

People older than ________ years have a higher incidence of ____________________________________________________________ than younger people, which is why diaphragms or cervical caps may not be ideal for them

Threatens a pregnant person's life Involves a fetus diagnosed with chromosomal defect Is unwanted because it is the result of rape or incest Is unwanted because the person chooses not to have a child at this time in their life for reasons such as being too young, a single parent, having financial difficulties, or from failed contraception

Reasons why elective termination of pregnancy is requested

Nausea Weight Gain Headache Breast Tenderness Breakthrough bleeding Molinial vaginal infections Mild Hypertension Depression

Side effects of COCs include

weight gain, headache, depression, irregular menstrual cycle and no menstrual bleeding for the first year

Side effects of DMPA include

-Irregular menstrual cycle -spotting -breakthrough bleeding -amenorrhea

Side effects of subdermal implants include

take COCs daily

Someone who is cognitively challenged might not understand the need to ___________________________________________________

insert a diaphragm or vaginal ring

Someone with unsteady coordination may find difficult to ________________________________

3-5, 7

Sperm can survive from __________days and rarely as many as __ days in the female reproductive tract so it is recommended that a person combines this with a calendar method so that they abstain for a few days before ovulation.

6 months

Spermatozoa that were present in the vas deferens at the time of vasectomy can remain viable for as long as how long?

26 and 32, first day of menstrual flow, safe days, fertile days, safe days

Standard Days Method: CycleBeads is designed for people who have menstrual cycle between ______________ days. A person purchases a circle of beads that help predict fertile day. First bead on the ring is red and marks the ___________________________________________, which is followed by six brown beads which indicate_______________. 12 glow in the dark white beads which mark __________________ and 13 additional brown _________________ follow.

copper t380 (ParaGard)

T-shaped plastic device wound with copper

major muscle, fifth day

The DMPA injection is made deep into a ______________________________ before the ________________________ after the beginning of a menstrual flow

loose enough at the penis tip

The condom should be positioned so it is __________________________________________________________ to collect the ejaculate without placing undue pressure on the condom.

flaccid

The penis should be withdrawn before it becomes _________________ after ejaculation to prevent sperm from leaking

1, too short, too long

The person advances _____ bead per day during the month. If they reach a dark brown bead (appears on the 27th day) before they begin their next menses, their cycle is ____________ for the method to be reliable. If they reach the end of the string of the beads (32 days) before menses, they know their cycle is ___________ for the method to be reliable.

Mini-pills

They have the disadvantage of causing more breakthrough bleeding than combination pills

3, fourth

Transdermal patches are applied each week for _______ weeks. No patch is applied the _________week

obese

Transdermal patches may be less effective to people who are

4-6 hours

Tubal ligation can be done as soon as _________________ after the birth of a baby

decidua

What do you call the endometrium when it continues to grow in thickness and vascularity instead of sloughing off?

patient's ability to pay for them and their ability to follow instruction faithfully

When discussing COCs, be certain to assess both a _______________________________________________________________ and ______________________________________________________________

84, 3, 4

With extended-use pills, pills are taken for _______________ days and patient will have menstrual flow every __________ months or _________ times a year

mild vaginal spotting, cramping, 2 weeks

With medical abortion, a patient can expect to have _____________________________________________________ and perhaps __________________________ for ____________________ post procedure

bad

Women over the age of 35 are _____ candidates for COCs

Counseling about surgical methods

___________________________ should be especially intensive for people younger than 30 years of age

Two-day method

a person assesses for vaginal secretions daily. If they feel secretions for 2 days in a row, they avoid coitus on that day and they day following as the presence of secretions suggest fertility.

Vasectomy

a small incision or puncture wound is made on each side of the scrotum. The vas deferens at that point is then located, cut and tied, cauterized, or plugged, blocking the passage of spermatozoa

Dilatation and extraction

a variation of dilatation and evacuation used after the gestational age that a D&E can no longer be completed

estrogen

acts to suppress follicle stimulating hormone (FSH) and LH, thereby suppressing ovulation

Spermicide

an agent that causes the death of sperm before they can enter the cervix; a chemical barrier method and is often used in combination with other physical barrier methods. Also alter the vaginal pH to a strong acid level.

Cervical mucus method

another method to predict ovulation. Before ovulation each month, the cervical mucus is thick and does not stretch when pulled between the thumb and finger. Just before ovulation, mucus secretion increases. For this method, a person must be conscientious about assessing their vaginal secretions everyday so that they don't miss the change in texture or amount

Barrier methods

are forms of birth control that place a chemical or latex barrier between the cervix and advancing sperm so sperm cannot reach and fertilize an ovum

Perimenopausal people

are good candidates for natural family planning methods because they might not be able to use hormonal methods

Cervical cap

are made of soft rubber, are shaped like a thimble with a thin rim, and fit snugly over the uterine cervix

Female condoms

are sheaths made of latex or polyurethane prelubricated with a spermicide

Levonogestrel 1.5mg

available over the counter for both sexes without a prescription

Nexplanon

can be embedded just under the skin on the inside of the upper arm where it will slowly release progestin over a period of 3 years

Electric vacuum aspiration

can be performed up to 14 weeks as it can accomodate larger cannulas

Manual vacuum aspiration

can be used 5 to 7 weeks after the last menstrual period where a narrow polyethylene catheter is introduced through the vagina into the cervix into the uterus.

Mifepristone 25 or 50 mg dose

can be used up to 120 hours after unprotected sex, more effective than plan b but lacks availability

progesterone

causing a decrease in the permeability of cervical mucus, thereby limiting sperm motility and access to ova.

Diaphragm

circular rubber disk that is placed over the cervix before intercourse to mechanically halt the passage of sperm

Symptothermal method

combines cervical mucus and BBT method and also observe for other signs of ovulation such as mittelschmerz or if the cervix feels shorter than usual. More effective than BBT or cervical mucus method.

Marquette model

combines the use of ovulation detection with other signs of ovulation to avoid pregnancy during the fertile period.

Biphasic preparations

deliver a constant amount of estrogen throughout the cycle but varying amounts of progestin

Standard Days Method: CycleBeads

designed for people who have menstrual cycle between 26 and 32 days. A person purchases a circle of beads that help predict fertile day. First bead on the ring is red and marks the first day of menstrual flow, which is followed by six brown beads which indicate "safe" days. 12 glow in the dark white beads which mark fertile days and 13 additional brown "safe" days follow. The person advances one bead per day during the month. If they reach a dark brown bead (appears on the 27th day) before they begin their next menses, their cycle is too short for the method to be reliable. If they reach the end of the string of the beads (32 days) before menses, they know their cycle is too long for the method to be reliable.

Lactation amenorrhea method

during breastfeeding, there is a natural suppression of both ovulation and menses. This method is related to that

levonorgestrel-releasing intrauterine system 52-mg (Mirena or Liletta)

features a drug reservoir of progesterone in the stem. Prevents endometrium proliferation and thickens cervical mucus. Lasts for 5-7 years

NuvaRing and Annovera

flexible silicone vaginal rings that when placed in the vagina, releases a combination of estrogen and progesterone

single intramuscular injection of medroxyprogesterone acetate (Depo-Provera [DMPA])

given every 12 weeks inhibits ovulation, alters the endometrium, and changes the cervical mucus

Reproductive life planning

includes all the decisions an individual or couple make about whether and when to have children, how many children to have , and how they are spaced

Methotrexate (Trexall)

interferes with the DNA synthesis of dividing cells and so prevents the growth of zygote

Mifepristone (RU-486 or Mifeprex)

is a progesterone antagonist that blocks the effect of progesterone, preventing implantation of the fertilized ovum and therefore causing the pregnancy to be lost

Evaluation

is important in RLF because anything that causes patients to discontinue or misuse a particular contraceptive method will leave them at risk for pregnancy

Dilatation and vacuum extraction

is used with terminations between 14 and 26 weeks of gestation in either an inpatient or ambulatory setting

0.5 F., full Farenheit degree (0.2 C)

just before the day of ovulation, BBT falls about _________ At the time of ovulation, BBT rises a ________________________ because of the rise in progesterone with ovulation. To do this, a person takes their temperature either orally or tympanic each morning before rising from bed.

Basal Body Temperature Method

just before the day of ovulation, ______ falls about 0.5 F. At the time of ovulation, ________ rises a full Farenheit degree (0.2 C) because of the rise in progesterone with ovulation. To do this, a person takes their temperature either orally or tympanic each morning before rising from bed.

Male condoms

latex rubber or syntethic sheath that is placed over the erect penis before coitus to trap sperm

levonorgestrel-releasing intrauterine system 13.5-mg (Skyla)

lower dose of progesterone in the stem compared to Mirena. more likely to have unscheduled bleeding compared to Mirena

levonorgestrel-releasing intrauterine system 19-mg (Kyleena)

lower dose than Mirena but higher than Skyla. approved for 5 years

Abstinence

method that offers 100% protection against pregnancy

Periodic abstinence

method to avoid pregnancy by avoiding sex on the days conception may be possible.

Natural family planning

methods that involve no introduction of chemical or foreign material into the body

Mittelschmerz

midcycle abdominal pain

Dilatation and extraction

most commonly used if the fetus is discovered to have a congenital anomaly that would be incompatible with life or would result in a severely compromised child

Ulipristal acetate (Ella)

newer form of pill, which can be taken 120 hours after unprotected intercourse

Intrauterine device

prevent fertilization as well as to create a local inflammatory reaction that prevents implantation

Monophasic pills

provide fixed doses of both estrogen and progestin throughout a 21-day cycle

Transdermal contraception

refers to patches that slowly but continuously release a combination of estrogen and progesterone

Abstinence

refraining from sexual relations, has 0% theoretical failure and is the most effective way to prevent STIs. This method has a high failure rate because it is difficult for many people to adhere to abstinence

Fertility awareness methods

rely on detecting when a person will be capable of impregnation so they can use periods of abstinence during that time

fimbriectomy

removal of fimbria at the distal end of the tubes

salpingectomy

removal of the entire fallopian tube and fimbria

Hysterotomy

removal of the fetus by surgery when the gestational age of pregnancy is more than about 20 to 24 weeks

hysterectomy

removal of the uterus or ovaries

Calendar method

requires a person to abstain from coitus on the days of a menstrual cycle when they are most likely to conceive. They keep a diary of about six menstrual cycles

posttubal ligation syndrome

severe lower abdominal cramping after tubal ligation

Intrauterine device

small plastic device that is inserted into the uterus through the vagina

Essure

system used between 2002 and 2019 that consisted of a spring-loaded mechanism that, when inserted through the vagina and uterus into a fallopian tube released a soft micro-insert into the tube.

3 months

the SC version of DMPA is given every _____________________________

dysmenorrhea

the copper IUD is not advised for patients with __________________________

Ovulation Detection

these kits detect the midcycle surge of LH that can be detected in urine 12 to 24 hours before ovulation. Such kits are 98% to 100% in effectiveness

Postcoital douching

this is very ineffective, since the sperm reaches the cervical mucus right after 90 secs of ejaculation, long before douching could be accomplished

anywhere from 3 to 5 days

typical length of sperm survival

Triphasic preparations

vary in both estrogen and progestin content throughout the cycle.

Coitus interruptus/withdrawal

when a het couple proceeds with coitus until the moment of ejaculation, it is not safe since ejaculation may occur before withdrawal and there might be spermatozoa present in the pre-ejaculation fluid.

laparoscopy

where a small incision is made in the abdomen for the purpose of viewing or performing surgery on the organs of the pelvis or abdomen.

Tubal ligation

where the fallopian tubes are occluded by cautery, crushing, clamping, or blocking, thereby preventing passage of both sperm and ova.