Module 01 - Contraception

▪ possible risk of acquiring TSS ▪ Risk of allergic reaction ▪ Does not protect against STIs

Disadvantages: *Cervical Cap* ATI Ch 1

▪ Do not use if menstrual cycles are short or long ▪ Possible pregnancy ▪ Less effective with hormonal contraceptives, IUD, breastfeeding

Risks: *Standard days method (cycle beads)* ATI Ch 1

spinnbarkeit sign

The ability for the cervical mucus to stretch between the fingers

24 hr

The human ovum can be fertilized ___ hr after ovulation. ATI Ch 1

Ages 15-44

What's considered the reproductive ages? Mod 1 Lesson Content

▪ Simple and easy to use

Advantages: *2-day method* ATI Ch 1

▪ Can have repeated acts of intercourse ▪ Easy to insert

Advantages: *Contraceptive Sponge* ATI Ch 1

▪ Use with a spermicide increases its effectiveness ▪ Insert up to 6 hr before intercourse, and leave in place at least 6 hr after intercourse but for no more than 48 hr at a time ▪ Replace q 2 years and refit after any gynecological surgery, birth, or any major weight fluctuation

Client Education: *Cervical Cap* ATI Ch 1

▪ infection ▪ cystocele (bladder prolapse) ▪ rectocele ▪ retroflexed or irregular shaped uterus

Contraindications: *Diaphragm* **On Exam**

Emergency oral contraceptive

*Name this type of hormonal contraception* Morning-after pill that prevents fertilization from taking place by inhibiting ovulation and the transport of sperm ATI Ch 1

▪ Most effective method of birth control ▪ Can eliminate the risk of STIs if there is no genitalia contact

Advantages: *Abstinence* ATI Ch 1

▪ Inexpensive ▪ Convenient ▪ No adverse effects

Advantages: *Basal Body Temperature (BBT)* ATI Ch 1

▪ Most useful when combined with basal body temperature or cervical mucus method ▪ Inexpensive

Advantages: *Calendar Rhythm Method* ATI Ch 1

▪ Refrain from sexual intercourse ▪ Discuss permissible sexual activities with partners

Client Education: *Abstinence* ATI Ch 1

▪ Be aware that pre-ejaculatory fluid can leak from the penis prior to ejaculation. It can contain sperm, which can fertilize an ovum.

Client Education: *Coitus interruptus (withdrawal)* ATI Ch 1

▪ One size fits all ▪ Moisten with water prior to insertion in the vagina ▪ Should be left in place for 6 hr after the last act of intercourse and provides protection for up to 24 hr

Client Education: *Contraceptive Sponge* ATI Ch 1

▪ Take within 72 hr after unprotected coitus ▪ A provider will recommend an OTC antiemetic to be taken 1 hr prior to each dose to counteract the adverse effects of nausea that can occur with high doses of estrogen and progestin ▪ Be evaluated for pregnancy if menstruation does not begin within 21 days ▪ Consider counseling about contraception and modification of sexual behaviors that are risky ▪ A copper IUD can be used up to 5 days following unprotected intercourse as an emergency contraceptive, but a prescription is required ▪ know it does NOT cause abortion or hurt a baby

Client Education: *Emergency Oral Contraceptive* ATI Ch 1

▪ Does not protect against STIs

Disadvantages: *Contraceptive Sponge* ATI Ch 1

▪ Complicated to use ▪ Bulky ▪ Noisy during intercourse ▪ More expensive than male condoms

Disadvantages: *Female Condoms* ATI Ch 1

▪ Messy ▪ Must reapply after each act of intercourse ▪ Does not protect against STIs

Disadvantages: *Spermicide* ATI Ch 1

48 to 72 hr

Motile sperm's ability to fertilize the ovum lasts an average of ___ to ___ hr. ATI Ch 1

▪ Diaphragm ▪ Cervical Cap ▪ Condoms (Male and Female) ▪ Spermicides ▪ Contraceptive Sponge

Name the *Barrier Methods* for contraception (5) Mod 1 Lesson Content

▪ Risk of TSS if left in the vagina greater than 24 hr

Risks: *Contraceptive Sponge* ATI Ch 1

▪ Contraindicated in clients who have cervical infections ▪ Spermicides that contain nonoxynol-9 (N-9) can cause lesions and increase the risk of HIV if used more than twice daily. Clients at high risk for STI should not use products containing N-9.

Risks: *Spermicide* ATI Ch 1

Natural Family Planning (NFP)

*Name this class of contraception* A contraceptive method that involves identifying the fertile period and avoiding intercourse during that time every cycle. No introduction of chemical or foreign material into the body. Mod 1 Lesson Content

Fertility Awareness-Based Methods (FAMs)

*Name this class of contraception* Includes identifying the fertile time during the cycle and use abstinence or other contraceptive methods during the fertile periods. These methods require motivation and considerable counseling to be used effectively. They may interfere with sexual spontaneity and require several months of symptom/cycle charting before they may be used effectively. Mod 1 Lesson Content

Diaphragm

*Name this type of barrier method contraception* A dome-shaped cup with a flexible rim made of silicone that fits snugly over the cervix. The effectiveness is increased with the use of a spermicidal cream or gel placed into the dome and around the rim. Available in different sizes. ATI Ch 1

cervical cap

*Name this type of barrier method contraception* Silicone rubber cap that fits tightly around the base of the cervix. This serves as a physical barrier against sperm entering the cervix. Comes in three sizes. ATI Ch 1

Contraceptive sponge

*Name this type of barrier method contraception* Small, round, concave-shaped, polyurethane sponge containing spermicide. It fits over the cervix and acts as a physical/chemical barrier against sperm from entering the vagina. ATI Ch 1

female condom

*Name this type of barrier method contraception* Vaginal sheath made of nitrile, a nonlatex synthetic rubber with flexible rings on both ends that is pre-lubricated with a spermicide ATI Ch 1

spermicide

*Name this type of barrier method contraception* chemical barrier that is available in a variety of forms, and destroys sperm before they can enter the cervix. It causes the vaginal flora to be more acidic, which is not favorable for sperm survival. ATI Ch 1

sterilization

*Name this type of contraception* A male vasectomy / female tubal ligation. Mod 1 Lesson Content

2-day method

*Name this type of contraception* A symptom-based method that involves checking for vaginal secretions daily, with no analysis of secretions. After 2 days without the presence of secretions, the fertile period has passed. ATI Ch 1

cervical mucus ovulation detection method

*Name this type of contraception* Fertility awareness method (also known as Billings method) is a symptom-based method in which the client analyzes cervical mucus to determine ovulation. ATI Ch 1

Depo-Provera

*Name this type of contraception* Injected every three months. Reversible, after ten months. Causes a temporary reduction in bone mineral density. Side effects include the following: irregular bleeding, weight gain, depression, headache, breast tenderness. This medication is safe for breastfeeding mothers. Mod 1 Lesson Content

calendar rhythm method

*Name this type of contraception* Involves determining fertile days by tracking the menstrual cycle to estimate the time of ovulation, which occurs about 14 days before the onset of the next menstrual cycle. This method can be used to facilitate conception or be used as a natural contraceptive. The client abstains from intercourse during the fertile period. ATI Ch 1

Standard days method (cycle beads)

*Name this type of contraception* More modern form of the calendar method that uses a standard number of fertile days for each cycle. The cycle beads are color-coded and located on a stringed necklace. ATI Ch 1

abstinence

*Name this type of fertility-awareness based method of contraception* Abstaining from sexual intercourse. Mod 1 Lesson Content

coitus interruptus

*Name this type of fertility-awareness based method of contraception* Also known as withdrawal. This approach is one of the oldest methods. Mod 1 Lesson Content

Lactation Amenorrhea Method

*Name this type of fertility-awareness based method of contraception* An infant is; under six months of age, being breastfed every 4 hours during the day and every 6 hours during the night, receives no supplementary feedings, and menses has not returned. Mod 1 Lesson Content

Basal Body Temperature

*Name this type of fertility-awareness based method of contraception* Entails taking a woman's temperature each morning and look for a rise of 0.5 - 1°F. The increase in temperature is evidence that ovulation has occurred about one day (24-36 hours) prior. Mod 1 Lesson Content

Combined oral contraceptives (COCs)

*Name this type of hormonal contraception* Hormonal contraception containing both estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation. ATI Ch 1

Progestin-only pills (minipill)

*Name this type of hormonal contraception* Oral progestins that provide the same action as combined oral contraceptives, which decreases the chance of fertilization and implantation. ATI Ch 1

*C*. The nurse should inform the team members that a Magnet hospital is one that stresses exemplary nursing care. It does not necessarily denote care for acute patients. This designation is not conferred by the American Medical Association.

A nursing assistant informed the nurse that Mr. Chung asked why the hospital where his baby is being cared for is termed a "Magnet hospital." The nurse would want team members to know which rationale? a. Magnet hospitals are those who care for the most acutely ill patients. b. The designation is one assigned by the American Medical Association. c. The hospital has met high standards for nursing competency. d. The term refers to hospitals that only admit a limited number of patients. Ch 1 Qs

▪ Extended period of use ▪ No additional application of spermicide needed

Advantages: *Cervical Cap* ATI Ch 1

▪ A client can become knowledgeable in recognizing their own mucus characteristics at ovulation, and self-evaluation can be very accurate ▪ Self-evaluation of cervical mucus can be diagnostically helpful in determining the start of ovulation while breastfeeding and planning a desired pregnancy.

Advantages: *Cervical Mucus Ovulation Detection Method* ATI Ch 1

▪ Possible choice for monogamous couple who do not have any other contraceptives available

Advantages: *Coitus interruptus (withdrawal)* ATI Ch 1

▪ Highly effective if taken correctly and consistently, preferable at the same time each day ▪ Hormonal contraception containing low-dose estrogen (less than 35 mcg) has other therapeutic effects, including decreased menstrual blood loss, decrease iron deficiency anemia, regulation of menorrhagia and irregular cycles, and reduced incidence of dysmenorrhea and premenstrual findings. ▪ Offers protection against endometrial, ovarian, and colon cancer, reduces the incidence of benign breast disease, improves acne, and protects against the development of functional ovarian cysts

Advantages: *Combined Oral Contraceptives (COCs)* ATI Ch 1

▪ Gives a client more control over contraception ▪ Easy to insert

Advantages: *Diaphragm* ATI Ch 1

▪ not taken on a regular basis ▪ anyone, regardless of age, is allowed to purchase at a pharmacy ▪ directions are easy to understand

Advantages: *Emergency Oral Contraceptive* ATI Ch 1

▪ Offers protection against pregnancy and STIs ▪ Offers some protection against STI transmitted by skin-to-skin contact (HPV, HSV, syphilis)

Advantages: *Female Condoms* ATI Ch 1

▪ Protects against most STIs ▪ Involves males in the birth control method ▪ No adverse effects ▪ Readily accessible

Advantages: *Male Condoms* ATI Ch 1

▪ Fewer adverse effects when compared with a combined oral contraceptive ▪ Considered safe to take while breastfeeding

Advantages: *Progestin-Only Pills (Minipill)* ATI Ch 1

▪ No Rx needed ▪ Increased the effectiveness of other methods of contraception when used together ▪ Various preparations (suppositories, foams, creams, gel, films)

Advantages: *Spermicide* ATI Ch 1

▪ Increased adherence by using a visual aid ▪ Mobile app available ▪ Easy to understand

Advantages: *Standard days method (cycle beads)* ATI Ch 1

▪ If vaginal secretions are present 2 days in a row, avoid unprotected intercourse to prevent pregnancy

Client Education: *2-day method* ATI Ch 1

▪ Take temperature immediately after waking up and before getting out of bed. If working at night, take temperature after awakening from the longest sleep cycle. Use a thermometer that records temperature to the tenths. Record the temperatures on a specialized graph. ▪ The first day the temperature drops or elevates is considered the first fertile day. Fertility extends through 3 consecutive days of temperature elevations ▪ Use this method with the calendar method to increase effectiveness

Client Education: *Basal Body Temperature (BBT)* ATI Ch 1

▪ Maintain a diary. Accurately record the number of days in each menstrual cycle, counting from the first day of menses for a period of at least six menstrual cycles. ▪ The start of the fertile period is established by subtracting 18 days from the number of days in the shortest menstrual cycle. ▪ The end of the fertile period is established by subtracting 11 days from the number of days of the longest cycle.

Client Education: *Calendar Rhythm Method* ATI Ch 1

▪ Use this method with the calendar method to increase effectiveness ▪ Engage in good hand hygiene prior to and following assessment ▪ Begin examining mucus from the last day of the menstrual cycle ▪ Mucus is obtained from the vaginal introitus. It is not necessary to reach into the vagina to the cervix. ▪ Use fingers or tissue paper to examine the cervical mucus. ▪ The stretchy consistency of egg whites is a good example of how cervical mucus will appear during ovulation. ▪ Do not douche prior to assessment

Client Education: *Cervical Mucus Ovulation Detection Method* ATI Ch 1

▪ Requires Rx and follow-up appointments ▪ Routine Pap smears and breast examination might be needed ▪ Medication requires consistent and proper use to be effective ▪ Regular menstrual cycles should occur during the last 7 days ▪ Observe for and report manifestations of complications (chest pain, SOB, leg pain [thromboembolism], headache, vision changes [stroke], hypertension) ▪ In the event of missing a dose, if one pill is missed, take one as soon as possible; if two or three pills are missed, follow the manufacturer's instructions. Instruct the client on the use of alternative forms of contraception or abstinence to prevent pregnancy until regular dosing is resumed. ▪ If nausea occurs, take at bedtime

Client Education: *Combined Oral Contraceptives (COCs)* ATI Ch 1

▪ Be properly fitted with a diaphragm by a provider. ▪ Replace q 2 years and refit for a 20% weight fluctuation, after abdominal or pelvic surgery, and after every pregnancy ▪ The diaphragm requires proper insertion and removal ▪ Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or cream that is applied to the cervical side of the dome and around the rim. The diaphragm can be inserted up to 6 hr before intercourse and **must stay in place 6 hr after intercourse but for no more than 24 hr.** ▪ Spermicide must be reapplied with each act of coitus ▪ Empty the bladder prior to insertion of the diaphragm, to decrease pressure on the urethra ▪ The diaphragm should be washed with mild soap and warm water after each use

Client Education: *Diaphragm* ATI Ch 1 **On Exam**

▪ The closed end of the condom pouch is inserted into the vagina by the client prior to intercourse and anchored around the cervix. The open ring of the condom covered the labia. The condom is removed and thrown away after each act of intercourse ▪ Do not use in conjunction with a male condom.

Client Education: *Female Condoms* ATI Ch 1

▪ Place a condom on the erect penis, leaving an empty space at the tip for a sperm reservoir ▪ **Following ejaculation, withdraw the penis from the vagina while holding the rim of the condom to prevent any semen spillage to the vulva or vaginal area. So don't withdraw if flaccid...** ▪ Can use in conjunction with spermicidal gel or cream to increase effectiveness ▪ Check expiration date prior to use. ▪ Latex and polyurethane condoms protect against STI, but natural skin (made out of lamb cecum) condoms do not because they have small pores. ▪ Polyurethane condoms can slip or lose shape more easily than latex, and therefore might not be as effective ▪ Only water-soluble lubricants should be used with latex condoms, to avoid condom breakage

Client Education: *Male Condoms* ATI Ch 1 **On Exam**

▪ Take the pill at the same time daily to ensure effectiveness secondary to a low dose of progestin ▪ Do not miss a pill ▪ Might need another form of birth control during the first month of use to prevent pregnancy

Client Education: *Progestin-Only Pills (Minipill)* ATI Ch 1

▪ Plan to insert spermicide 15 min before intercourse. Spermicide is only effective for 1 hr (so do NOT administer more than 1 hr before sex) after insertion, but should not be removed until 6 hr after intercourse ▪ Fold films prior to use and insert in the vagina, where it will dissolve.

Client Education: *Spermicide* ATI Ch 1 **On Exam**

▪ Start the first day of the menstrual cycle. Use a rubber ring to advance one bead per day. ▪ Red bead: the first bead and marks the first day of the menstrual cycle ▪ Brown beads: non fertile days ▪ White beads: fertile days

Client Education: *Standard days method (cycle beads)* ATI Ch 1

*A*. The nurse should teach Dana that tubal ligation is a minor surgical procedure in which the fallopian tubes are occluded by cautery, crushed, clamped, or blocked, thereby preventing passage of both sperm and ova.

Dana, 17 years old, e-mails the nurse to ask how a tubal ligation prevents pregnancy. To be certain she's fully informed, which would be the nurse's best answer? a. Sperm can no longer reach the ova because fallopian tubes are blocked. b. Sperm cannot enter the uterus because the cervical entrance is blocked. c. Prostaglandins released from the cut fallopian tubes effectively kill sperm. d. The ovary no longer releases ova because there is nowhere for them to go. Ch 6 Qs

*B*. The nursing care plan for Dana should include teaching her that female condoms should be inserted before any sexual contact, they should not be reused, and they already contain a spermicide.

Dana, 17 years old, wants to try female condoms as her reproductive planning method. If the nurse was creating a relevant educational handout, it should include which of the following directives? a. The hormone that condom use stimulates may cause mild weight gain. b. Female condoms should be inserted before any penile penetration. c. Women should coat the condom with a spermicide before use. d. Female condoms, unlike male condoms, can be reused after being washed. Ch 6 Qs

▪ Requires daily assessment for vaginal secretions

Disadvantages: *2-day method* ATI Ch 1

▪ Requires self-control ▪ High failure rate due to lack of adherence

Disadvantages: *Abstinence* ATI Ch 1

▪ Reliability can be influenced by many variables that can cause inaccurate interpretation of temperature changes (stress, fatigue, illness, alcohol, warmth of sleeping environment). ▪ Dose not protect against STIs

Disadvantages: *Basal Body Temperature (BBT)* ATI Ch 1

▪ Not a very reliable technique ▪ Does not protect against STIs ▪ Requires accurate record-keeping ▪ Requires adherence regarding abstinence during fertile periods

Disadvantages: *Calendar Rhythm Method* ATI Ch 1

▪ Some clients are uncomfortable with touching their genitals and mucus, and therefore find this method objectionable. ▪ Self-analysis of cervical mucus can be difficult ▪ Does not protect against STIs

Disadvantages: *Cervical Mucus Ovulation Detection Method* ATI Ch 1

▪ One of the least effective methods of contraception ▪ No protection against STIs

Disadvantages: *Coitus interruptus (withdrawal)* ATI Ch 1

▪ Does not protect against STIs ▪ Can increase the risk of thromboembolism, stroke, heart attack, hypertension, gallbladder disease, and liver tumor. ▪ Exacerbates condition affected by fluid retention (migraine, epilepsy, asthma, kidney or heart disease) ▪ Adverse effects include headache, nausea, breast tenderness, and breakthrough bleeding.

Disadvantages: *Combined Oral Contraceptives (COCs)* ATI Ch 1

▪ Inconvenient, interfere with spontaneity, and require reapplication with spermicidal gel, cream, or foam with each act of coitus to be effective ▪ Requires a prescription and a visit to a provider ▪ Must be inserted correctly to be effective ▪ Does not protect against STIs

Disadvantages: *Diaphragm* ATI Ch 1

▪ High rate of nonadherence ▪ Can reduce spontaneity of intercourse ▪ Decreased sensation ▪ The penis must be erect to apply a condom ▪ Withdrawing the penis while still erect can interfere with sexual intercourse ▪ Does not protect against STIs that are transmitted from lesions on the skin or mucus membranes (HPV, HSV, syphilis) ▪ Condoms have a one-time usage, which creates a replacement cost

Disadvantages: *Male Condoms* ATI Ch 1

▪ Less effective in suppressing ovulation than combined oral contraceptives ▪ Increased occurrence of ovarian cysts ▪ No protection against STIs ▪ Adverse effects include breakthrough, irregular, vaginal bleedings (frequently reported/most common), headache, nausea, and breast tenderness

Disadvantages: *Progestin-Only Pills (Minipill)* ATI Ch 1

▪ Unreliable for menstrual cycles longer than 32 days or shorter than 26 days ▪ Can lose track of the days

Disadvantages: *Standard days method (cycle beads)* ATI Ch 1

1. Congenital malformations and chromosomal abnormalities 2. Disorders related to short gestation age and low birth weight 3. Maternal complications of pregnancy 4. Sudden infant death syndrome 5. Unintentional injuries (accidents)

Major Causes of Death in Childhood: Under 1 Year Ch 1

*D*. The nurse should explain that consent is required for all patients regardless of age and the amount of pain involved in the procedure and can be given by telephone or e-mail for long distance consultation.

Melissa Chung is concerned as to how she will give consent for procedures for her newborn baby because the baby is hospitalized so far away. Which statement would be best to reassure her? a. "Informed consent is not needed for newborn care as newborns are underage." b. "Newborn care requires parental consent only for procedures that will involve pain." c. "Healthcare providers can omit informed consent if the parent is not present with the child." d. "Consent is required: you can be contacted by telephone or e-mail for long distance consultation." Ch 1 Qs

*B*. The nurse should acknowledge the patient's concerns while affirming her efforts rather than downplaying her concerns or providing false assurance.

Mrs. Chung waited until she was 42 years old to have her second baby. She asks the nurse if that is the reason her baby was born prematurely. Which statement would be the most reassuring for her? a. "It's hard to say because so few women over 40 years are having babies today." b. "No one can say for certain. You did all you could to ensure a healthy pregnancy." c. "It's good to see you taking responsibility for your child's prematurity." d. "You should ideally have had your children as a teenager as that's the safest time." Ch 1 Qs

*C*. The nurse explains that the perinatal period is the time between 20 weeks of pregnancy and 4 to 6 weeks following birth.

Mrs. Chung's doctor has told her that her baby's most dangerous time will be until the perinatal period ends. When does the perinatal period take place? a. From the day of birth until 1 month afterward b. During the time the infant will be on ventilator support c. From the 20th week of pregnancy to 4 to 6 weeks after birth d. Until the infant's body temperature stabilizes following birth Ch 1 Qs

▪ Hormone or copper-releasing IUD ▪ EC Plan B, and generic forms are available OTC now

Name the *Emergency Contraceptives* for contraception (2) Mod 1 Lesson Content

▪ Transdermal Patch ▪ Oral Contraceptives (OCP) ▪ Vaginal Ring

Name the *Hormonal Methods* for contraception (3) Mod 1 Lesson Content

▪ 1st: proliferative/estrogenic/follicular/postmenstrual phase. ▪ 2nd: luteal phase/secretory/progestational/premenstrual phase ▪ 3rd: ovulation/ischemic ▪ 4th: menstruation

Name the four phases of the menstrual cycle Worksheet

▪ Possible pregnancy

Risks: *2-day method* ATI Ch 1

▪ If complete abstinence is maintained, there are no risks

Risks: *Abstinence* ATI Ch 1

▪ Possible pregnancy

Risks: *Basal Body Temperature (BBT)* ATI Ch 1

▪ Various factors can affect and change the time of ovulation and cause unpredictable menstrual cycles ▪ Possible pregnancy due to miscalculating or not abstaining from intercourse during fertile days

Risks: *Calendar Rhythm Method* ATI Ch 1

▪ Not for clients who have abnormal Pap test results or those who have a history of TSS

Risks: *Cervical Cap* ATI Ch 1

▪ Assessment of cervical mucus characteristics can be inaccurate if mucus is mixed with semen, blood, contraceptive foams, or discharge from infections ▪ Sexual arousal or intercourse (thins secretions), or use of deodorants, douches, medication, or lubricants can alter cervical mucus appearance and affect accuracy ▪ Possible pregnancy

Risks: *Cervical Mucus Ovulation Detection Method* ATI Ch 1

▪ Possible pregnancy

Risks: *Coitus interruptus (withdrawal)* ATI Ch 1

▪ Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes (anticonvulsants, antifungals, and some antibiotics) ▪ *Contraindicated for clients who have a history of thromboembolic disorders, stroke, heart attack, coronary artery disease, gallbladder disease, cirrhosis or liver tumor, headache with focal neurologic findings, uncontrolled hypertension, diabetes mellitus with vascular involvement, breast or estrogen-related cancers, pregnancy, lactating, less than 6 weeks postpartum, or smoking (if over 35 years of age)*

Risks: *Combined Oral Contraceptives (COCs)* ATI Ch 1 **On Exam**

▪ Not recommended for clients who have a history of toxic shock syndrome (TSS), cystocele, uterine prolapse, or frequent, recurrent urinary tract infections ▪ Increased risk of acquiring TSS ▪ Allergic reaction and UTIs

Risks: *Diaphragm* ATI Ch 1

▪ Condoms can rupture or leak, potentially resulting in pregnancy ▪ Condoms made of latex should not be worn by those who are sensitive or allergic to latex

Risks: *Male Condoms* ATI Ch 1

▪ Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes (anticonvulsants, antifungals, and some antibiotics) ▪ Contraindicated for bariatric surgery, lupus, severe cirrhosis, liver tumors, and current or past breast cancer

Risks: *Progestin-Only Pills (Minipill)* ATI Ch 1

*B*. Intramuscular injections (DMPA) are associated with osteoporosis, so recommending a high calcium intake is important.

Suppose Dana, 17 years old, chooses intramuscular injections of DMPA as her method of reproductive life planning. What instructions would the nurse want members of the care team to give her with regard to this method? a. "Encourage Dana to limit cigarette smoking to no more than one pack per day." b. "Encourage Dana to drink a glass of milk or take a calcium supplement daily." c. "Teach Dana not to swim for longer than an hour at any one time." d. "Teach Dana not to expose the injection site to direct sunlight." Ch 6 Qs

*D*. The nurse should have Dana report severe migraine headaches because they are a contraindication to COCs.

Suppose Dana, 17 years old, chooses to use a combined oral contraceptive (COC) as her family planning method. What is a danger sign of COCs the nurse would ask her to report? a. A stuffy or runny nose b. Arthritis-like symptoms c. Weight gain over 5 lb d. Severe migraine headache Ch 6 Qs

*B*. The nurse should teach Dana that cervical mucus is thin and watery at ovulation. Subjective sensations of warmth, breast tenderness, and emotional lability are not safe and reliable indicators.

Suppose Dana, 17 years old, tells the nurse she wants to use a fertility awareness method of contraception. How should the nurse best meet Dana's learning needs? a. The nurse should teach her to record if she feels hot and whether she is perspiring heavily. b. The nurse should teach her to assess whether her cervical mucus is thin and watery. c. The nurse should teach her to monitor her emotions for sudden anger or crying. d. The nurse should teach her to assess whether her breasts feel sensitive to cool air. Ch 6 Qs