Exam 3 - Chapter 8

Question 1

A woman has chosen the calendar method of conception control. Which is the most
important action the nurse should perform during the assessment process?
a. Obtain a history of the womans menstrual cycle lengths for the past 6 to 12 months.
b. Determine the clients weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the clients previous experiences with conception control.

Answer 1

A

Question 2

A married couple is discussing alternatives for pregnancy prevention and has asked about
fertility awareness methods (FAMs). Which response by the nurse is most appropriate?
a. Theyre not very effective, and it is very likely that youll get pregnant.
b. FAMs can be effective for many couples; however, they require motivation.
c. These methods have a few advantages and several health risks.
d. You would be much safer going on the pill and not having to worry.

Answer 2

B - FAMs are effective with proper vigilance about ovulatory changes in the body and with
adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular
menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs
have no associated health risks. The use of birth control has associated health risks. In addition,
taking a pill daily requires compliance on the clients part.

Question 3

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily
asks the nurse about the pill as a contraceptive choice. What is the nurses best response?
a. Oral contraceptives are a highly effective method, but they have some side effects.
b. Your current medications will reduce the effectiveness of the pill.
c. Oral contraceptives will reduce the effectiveness of your seizure medication.
d. The pill is a good choice for a woman of your age and with your personal history.

Answer 3

B - Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are
simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control
method with side effects is a true statement, but this response is not the most appropriate.

Question 4

A woman who has just undergone a first-trimester abortion will be using oral

contraceptives. To protect against pregnancy, the client should be advised to do what?
a. Avoid sexual contact for at least 10 days after starting the pill.
b. Use condoms and foam for the first few weeks as a backup.
c. Use another method of contraception for 1 week after starting the pill.
d. Begin sexual relations once vaginal bleeding has ended

Answer 4

C - If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of
contraception should be used throughout the first week to avoid the risk of pregnancy.

Question 5

Which client would be an ideal candidate for injectable progestins such as Depo-Provera
(DMPA) as a contraceptive choice?
a. The ideal candidate for DMPA wants menstrual regularity and predictability.
b. The client has a history of thrombotic problems or breast cancer.
c. The ideal candidate has difficulty remembering to take oral contraceptives daily.
d. The client is homeless or mobile and rarely receives health care.

Answer 5

C - Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of
combined oral contraceptives, and the requirement of only four injections a year. The
disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use
of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To
be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care
is necessary to prevent pregnancy or potential complications.

Question 6

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse
to explain the major differences between the cervical cap and the diaphragm. What is the most
appropriate response by the nurse?
a. No spermicide is used with the cervical cap, so its less messy.
b. The diaphragm can be left in place longer after intercourse.
c. Repeated intercourse with the diaphragm is more convenient.
d. The cervical cap can be safely used for repeated acts of intercourse without adding more
spermicide later

Answer 6

D - The cervical cap can be inserted hours before sexual intercourse without the need for additional
spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The
cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated
intercourse with the cervical cap is more convenient because no additional spermicide is needed.

Question 7

Which statement regarding emergency contraception is correct?
a. Emergency contraception requires that the first dose be taken within 72 hours of
unprotected intercourse.
b. Emergency contraception may be taken right after ovulation.
c. Emergency contraception has an effectiveness rate in preventing pregnancy of
approximately 50%.
d. Emergency contraception is commonly associated with the side effect of menorrhagia.

Answer 7

A - Emergency contraception should be taken as soon as possible or within 72 hours of unprotected
intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited,
which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most
common side effect of postcoital contraception is nausea.

Question 8

An unmarried young woman describes her sex life as active and involving many partners.
She wants a contraceptive method that is reliable and does not interfere with sex. She requests an
intrauterine device (IUD). Which information is most important for the nurse to share?
a. The IUD does not interfere with sex.
b. The risk of pelvic inflammatory disease will be higher with the IUD.
c. The IUD will protect you from sexually transmitted infections.
d. Pregnancy rates are high with the IUD

Answer 8

B - Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first
20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The
IUD offers no protection against sexually transmitted infections (STIs) or the human
immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex
partners, she is at higher lroispkinogf deve an STI. Stating that an IUD does not interfere with
sex may be correct; however, it is not the most appropriate response. The typical failure rate of
the IUD is approximately 1%

Question 9

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the
most
common technique used for the termination of a pregnancy in the second trimester?
a. Dilation and evacuation (D&E)
b. Methotrexate administration
c. Prostaglandin administration
d. Vacuum aspiration

Answer 9

A - D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed
between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early
abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and
work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used
for abortions in the first trimester

Question 10

A woman will be taking oral contraceptives using a 28-day pack. What advice should the
nurse provide to protect this client from an unintended pregnancy?
a. Limit sexual contact for one cycle after starting the pill.
b. Use condoms and foam instead of the pill for as long as the client takes an antibiotic.
c. Take one pill at the same time every day.
d. Throw away the pack and use a backup method if two pills are missed during week 1 of
her cycle.

Answer 10

C - To maintain adequate hormone levels for contraception and to enhance compliance, clients
should take oral contraceptives at the same time each day. If contraceptives are to be started at
any time other than during normal menses or within 3 weeks after birth or an abortion, then
another method of contraception should be used through the first week to prevent the risk of
pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy
cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broadspectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses
two pills during week 1, then she should take two pills a day for 2 days and finish the package
and use a backup contraceptive method for the next 7 consecutive days.

Question 11

The lactational amenorrhea method (LAM) of birth control is popular in developing
countries and has had limited use in the United States. As breastfeeding rates increase, more
women may rely upon this method for birth control. Which information is most important to
provide to the client interested in using the LAM for contraception?
a. LAM is effective until the infant is 9 months of age.
b. This popular method of birth control works best if the mother is exclusively
breastfeeding.
c. Its typical failure rate is 5%.
d. Feeding intervals should be 6 hours during the day.

Answer 11

B - The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption
of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or
menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%.
Feeding intervals should be no greater than 4 hours during the day and 6 hours at night

Question 12

Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use
of a diaphragm. If a client is interested in this form of conception control, then the nurse must
instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would
be most helpful in achieving this goal?
a. You should always remove your diaphragm 6 to 8 hours after intercourse. Dont use the
diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever
over 38.4 C, hypotension, and a rash.
b. You should remove your diaphragm right after intercourse to prevent TSS.
c. Its okay to use your diaphragm during your menstrual cycle. Just be sure to wash it
thoroughly first to prevent TSS.
d. Make sure you dont leave your diaphragm in for longer than 24 hours, or you may get

Answer 12

A - The nurse should instruct the client on the proper use and removal of the diaphragm and include
the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to
prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS.
The diaphragm should not be used during menses.

Question 13

Which term best describes the conscious decision concerning when to conceive or avoid
pregnancy as opposed to the intentional prevention of pregnancy during intercourse?
a. Family planning
b. Birth control
c. Contraception
d. Assisted reproductive therapy

Answer 13

A - Family planning is the process of deciding when and if to have children. Birth control is the
device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is
the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy
is one of several possible treatments for infertility.

Question 14

In the acronym BRAIDED, which letter is used to identify the key components of
informed consent that the nurse must document?
a. B stands for birth control.
b. R stands for reproduction.
c. A stands for alternatives.
d. I stands for ineffective.

Answer 14

C - In the acronym BRAIDED, A stands for alternatives and information about other viable
methods. B stands for benefits and information about the advantages of a particular birth control
method and its success rates. Rstands for risks and information about the disadvantages of a
particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.

Question 15

Which benefit regarding FAMs makes it an appealing choice for some women?

a. Adherence to strict recordkeeping
b. Absence of chemicals and hormones
c. Decreased involvement and intimacy of partner
d. Increased spontaneity of coitus

Answer 15

B - The absence of chemicals or hormones to alter the natural menstrual flow is extremely important
to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk
for failure. These methods require increased involvement by the partner; however, they also
reduce the spontaneity of coitus.

Question 16

The nurse is providing contraceptive instruction to a young couple who are eager to learn.
The nurse should be cognizant of which information regarding the natural family planning
method?
a. The natural family planning method is the same as coitus interruptus or pulling out.
b. This contraception method uses the calendar method to align the womans cycle with the
natural phases of the moon.
c. This practice is the only contraceptive method acceptable to the Roman Catholic Church.
d. The natural family planning method relies on barrier methods during the fertility phases.

Answer 16

C - Natural family planning is the only contraceptive practice acceptable to the Roman Catholic
Church. Pulling out is not the same as periodic abstinence, another name for natural family
planning. The phases of the moon are not part of the calendar method or any method. Natural
family planning is another name for periodic abstinence, which is the accepted way to pass safely
through the fertility phases without relying on chemical or physical barriers.

Question 17

Which nonpharmacologic contraceptive method has a failure rate of less than 25%?

a. Standard days variation
b. Periodic abstinence
c. Postovulation
d. Coitus interruptus

Answer 17

A - The standard days variation on the calendar method has a failure rate of 12% and is a variation of
the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic
abstinence method has a failure rate of 25% or higher. The postovulation method has a failure
rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.

Question 18

Which contraceptive method best protects against STIs and the HIV?

a. Periodic abstinence
b. Barrier methods
c. Hormonal methods
d. Same protection with all methods

Answer 18

B - Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive
methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no
protection against STIs or the HIV.

Question 19

Nurses should be cognizant of what information with regard to the noncontraceptive
medical effects of combination oral contraceptives (COCs)?
a. COCs can cause TSS if the prescription is wrong.
b. Hormonal withdrawal bleeding is usually a little more profuse than in normal
menstruation and lasts a week for those who use COCs.
c. COCs increase the risk of endometrial and ovarian cancers.
d. Effectiveness of COCs can be altered by some over-the-counter medications and herbal
supplements.

Answer 19

D - The effectiveness of COCs can be altered by some over-the-counter medications and herbal
supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of
taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal
menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk
of endometrial and ovarian cancers.

Question 20

Importantly, the nurse must be aware of which information related to the use of IUDs?
a. Return to fertility can take several weeks after the device is removed.
b. IUDs containing copper can provide an emergency contraception option if inserted within
a few days of unprotected intercourse.
c. IUDs offer the same protection against STIs as the diaphragm.
d. Consent forms are not needed for IUD insertion

Answer 20

B - The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is
immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form
is required for insertion, as is a negative pregnancy test.

Question 21

Which statement is the most complete and accurate description of medical abortions?

a. Medical abortions are performed only for maternal health.
b. They can be achieved through surgical procedures or with drugs.
c. Medical abortions are mostly performed in the second trimester.
d. They can be either elective or therapeutic.

Answer 21

D - Medical abortions can be either elective (the womans choice) or therapeutic (for reasons of
maternal or fetal health) and are performed through the use of medications rather than surgical
procedures. Medical abortions are usually performed in the first trimester

Question 22

A woman is using the basal body temperature (BBT) method of contraception. She calls
the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone
up. What is the nurses mostappropriate response?
a. This probably means that youre pregnant.
b. Dont worry; its probably nothing.
c. Have you been sick this month?
d. You probably didnt ovulate during this cycle.

Answer 22

D - The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy
cannot occur without ovulation, which is being measured using the BBT method. A comment
such as, Dont worry; its probably nothing, discredits the clients concerns. Illness is most likely
the cause of an increase in BBT.

Question 23

A male client asks the nurse why it is better to purchase condoms that are not lubricated
with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate?
a. The lubricant prevents vaginal irritation.
b. Nonoxynol-9 does not provide protection against STIs as originally thought; it has also
been linked to an increase in the transmission of the HIV and can cause genital lesions.
c. The additional lubrication improves sex.
d. Nonoxynol-9 improves penile sensitivity.

Answer 23

B - Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been
linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9
may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on
penile sensitivity.

Question 24

Which statement regarding the term contraceptive failure rate is the most accurate?
a. The contraceptive failure rate refers to the percentage of users expected to have an
accidental pregnancy over a 5-year span.
b. It refers to the minimum rate that must be achieved to receive a government license.
c. The contraceptive failure rate increases over time as couples become more careless.
d. It varies from couple to couple, depending on the method and the users

Answer 24

D - Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive
method is used and how well it suits the couple. The contraceptive failure rate measures the
likelihood of accidental pregnancy in the first y. eFarilounrely users gain experience.

Question 25

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge
and expertise to assist women in making informed choices regarding contraception. A
multidisciplinary approach should ensure that the womans social, cultural, and interpersonal
needs are met. Which action should the nurse first take when meeting with a new client to
discuss contraception?
a. Obtain data about the frequency of coitus.
b. Determine the womans level of knowledge concerning contraception and her
commitment to any particular method.
c. Assess the womans willingness to touch her genitals and cervical mucus.
d. Evaluate the womans contraceptive life plan.

Answer 25

B - Determining the womans level of knowledge concerning contraception and her commitment to
any particular method is the primary step of this nursing assessment and necessary before
completing the process and moving on to a nursing diagnosis. Once the clients level of
knowledge is determined, the nurse can interact with the woman to compare options, reliability,
cost, comfort level, protection from STIs, and her partners willingness to participate. Although
important, obtaining data about the frequency of coitus is not the first action that the nurse
should undertake when completing an assessment. Data should include not only the frequency of
coitus but also the number of sexual partners, level of contraceptive involvement, and the
partners objections. Assessing the womans willingness to touch herself is a key factor for the
nurse to discuss should the client express an interest in using one of the fertility awareness
methods of contraception. The nurse must be aware of the clients plan regarding whether she is
attempting to prevent conception, delay conception, or conceive.

Question 26

What is the importance of obtaining informed consent for a number of contraceptive
methods?
a. Contraception is an invasive procedure that requires hospitalization.
b. The method may require a surgical procedure to insert a device.
c. The contraception method chosen may be unreliable.
d. The method chosen has potentially dangerous side effects.

Answer 26

D - Being aware of the potential side effects is important for couples who are making an informed
decision about the use of contraceptives. The only contraceptive method that is a surgical
procedure and requires hospitalization is sterilization. Some methods have greater efficacy than
others, and this efficacy should be included in the teaching.

Question 27

If consistently and correctly used, which of the barrier methods of contraception has the 
lowest failure rate?
a. Spermicides
b. Female condoms
c. Male condoms
d. Diaphragms

Answer 27

C - For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates
are approximately 28%. The failure rate for female condoms is approximately 21%. The failure
rate for diaphragms with spermicides is 12%

Question 28

The nurse is reviewing the educational packet provided to a client about tubal ligation.
Which information regarding this procedure is important for the nurse to share? (Select all that
apply.)
a. It is highly unlikely that you will become pregnant after the procedure.
b. Tubal ligation is an effective form of 100% permanent sterilization. You wont be able to
get pregnant.
c. Sterilization offers some form of protection against STIs.
d. Sterilization offers no protection against STIs.
e. Your menstrual cycle will greatly increase after your sterilization.

Answer 28

A,D - A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no
protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the
same after a tubal ligation.

Question 29

Postabortion instructions may differ among providers regarding tampon use and the
resumption of intercourse. However, education should be provided regarding serious
complications. When should the woman who has undergone an induced abortion be instructed to
return to the emergency department? (Select all that apply.)
a. Fever higher than 39 C
b. Chills
c. Foul-smelling vaginal discharge
d. Bleeding greater than four pads in 2 hours
e. Severe abdominal pain

Answer 29

B,C,E - The client should report to a health care facility for any of the following symptoms: fever higher
than 38 C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for
days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache

Question 30

The nurse is responsible for providing health teaching regarding the side effects of COCs.
These side effects are attributed to estrogen, progesterone, or both. Which side effects are related
to the use of COCs? (Select all that apply.)
a. Gallbladder disease
b. Myocardial infarction and stroke
c. Hypotension
d. Breast tenderness and fluid retention
e. Dry skin and scalp

Answer 30

A,B,D - Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and
liver tumors. More common side effects include nausea, breast tenderness, fluid retention,
increased appetite, oily skin and scalp, and chloasma

Question 31

The client and her partner are considering male sterilization as a form of permanent birth
control. While educating the client regarding the risks and benefits of the procedure, which
information should the nurse include? (Select all that apply.)
a. Sterilization should be performed under general anesthesia.
b. Pain, bleeding, and infection are possible complications.
c. Pregnancy may still be possible.
d. Vasectomy may affect potency.
e. Secondary sex characteristics are unaffected.

Answer 31

B,C,E - Vasectomy is the most commonly used procedure for male sterilization and is performed on an
outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered
complications. Reversal is generally unsuccessful; however, it may take several weeks to months
for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary
until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex
characteristics are not affected.