Chapter 8

Question 1

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 woman’s menstrual cycle lengths for the past 6 to 12 months.
   b. Determine the client’s weight gain and loss pattern for the previous year.
   c. Examine skin pigmentation and hair texture for hormonal changes.
   d. Explore the client’s previous experiences with conception control.

Answer 1

ANS: A
The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.

Question 2

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. “They’re not very effective, and it is very likely that you’ll 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

ANS: 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 client’s part.

Question 3

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 nurse’s 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

ANS: 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. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

Question 4

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

ANS: 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

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

ANS: 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

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 it’s 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

ANS: 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

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

ANS: 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

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

ANS: 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 risk of developing 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

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

ANS: 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

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

ANS: 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 broad-spectrum 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

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

ANS: 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

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. Don’t 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. “It’s okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS.”
    d. “Make sure you don’t leave your diaphragm in for longer than 24 hours, or you may get TSS.”

Answer 12

ANS: 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

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

ANS: 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

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

ANS: 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. R stands 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

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

ANS: 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

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 woman’s 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

ANS: 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

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

ANS: 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

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

ANS: 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

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

ANS: 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

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

ANS: 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

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

ANS: D
Medical abortions can be either elective (the woman’s 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

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 nurse’s most appropriate response?
    a. “This probably means that you’re pregnant.”
    b. “Don’t worry; it’s probably nothing.”
    c. “Have you been sick this month?”
    d. “You probably didn’t ovulate during this cycle.”

Answer 22

ANS: 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, “Don’t worry; it’s probably nothing,” discredits the client’s concerns. Illness is most likely the cause of an increase in BBT.

Question 23

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

ANS: 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

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

ANS: 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 year only. Failure rates decline over time because users gain experience.

Question 25

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 woman’s 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 woman’s level of knowledge concerning contraception and her commitment to any particular method.
    c. Assess the woman’s willingness to touch her genitals and cervical mucus.
    d. Evaluate the woman’s contraceptive life plan.

Answer 25

ANS: B
Determining the woman’s 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 client’s level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partner’s 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 partner’s objections. Assessing the woman’s 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 client’s plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

Question 26

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

ANS: 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

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

ANS: 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

1. 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 won’t 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

ANS: 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

2. 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

ANS: 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

3. 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

ANS: 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

4. 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

ANS: 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.

Question 32

1. The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the woman’s cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

Answer 32

ANS:
6; 19
To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

Question 33

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.” The nurse’s most appropriate response is:
A.“This probably means you’re pregnant.”
B. “Don’t worry; it’s probably nothing.”
C. “Have you been sick this month?”
D. “You probably didn’t ovulate during this cycle.”

Answer 33

Ans: D
Pregnancy cannot occur without ovulation (which is being measured using the BBT method). The absence of a temperature decrease most likely is the result of lack of ovulation. Illness would most likely cause an increase in BBT. A comment such as the one in B discredits the client’s concerns.

Question 34

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse’s most appropriate response is:
A. “The lubricant prevents vaginal irritation.”
B. “Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions.”
C. “The additional lubrication improves sex.”
D. “Nonoxynol-9 improves penile sensitivity.”

Answer 34

Ans: B
Answer B is a true statement. Nonoxynol-9 may cause vaginal irritation.
It has no effect on the quality of sexual activity or on penile sensitivity.

Question 35

A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should she and her partner avoid?
  A. Cervical cap 
  B. Condom
  C. Vaginal film
  D. Vaginal sheath

Answer 35

Ans: A
Women with a history of TSS should not use a cervical cap. Condoms, vaginal film, and vaginal sheaths are not contraindicated for a woman with a history of TSS.

Question 36

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

Answer 36

Ans: D
The contraceptive failure rate is strictly a statistical measure of likely accidental pregnancy over a couple’s first year of use. Failure rates decline over time because users gain experience. Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple.

Question 37

What important aspects do all the fertility awareness–based (FAB) methods have in common?
A. They all require a woman to be able to touch her genitals to assess cervical mucus.
B. They all involve abstinence at some point.
C. They all rely on measurement of body temperature.
D. They all require the cooperation of the woman’s partner.

Answer 37

Ans: D
Fertile phases can be determined in a number of ways, but the sexual partner must cooperate in the method. Not all FAB methods calculate fertility phases by examining mucus; some use body temperatures and other signs. Some methods use chemical or physical barriers to conception during fertile periods.

Question 38

With regard to emergency contraception pills, nurses should be aware that:
A. The pills should be readily available during the initial learning phase when a woman is using a new method of contraception.
B. The pills must be taken no later than 48 hours after unprotected intercourse or birth control mishap.
C. The pills protect the woman against pregnancy even if she engages in unprotected intercourse in the days after treatment.
D. Emergency contraception has no medical contraindications.

Answer 38

Ans: A
A backup method of birth control is also a good idea for beginners. The woman has up to 120 hours after unprotected intercourse to take emergency contraception pills; they do not, however, protect against pregnancy from subsequent unprotected intercourse. These pills are contraindicated during pregnancy and if the woman has undiagnosed abnormal vaginal bleeding.

Question 39

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 woman’s social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception?
A. Obtain data about the frequency of coitus.
B. Determine the woman’s level of knowledge about contraception and commitment to any particular method.
C. Assess the woman’s willingness to touch her genitals and cervical mucus.
D. Evaluate the woman’s contraceptive life plan.

Answer 39

Ans: B
All of these actions are part of the assessment, but determination of the woman’s level of knowledge regarding contraception and her commitment to a method is the primary step and is necessary before completing the process and moving on to a nursing diagnosis. Once the client’s level of knowledge is determined, the nurse can interact with her to compare options, reliability, cost, comfort level, protection from sexually transmitted infections (STIs), and a partner’s willingness to participate. Data about frequency of coitus should include the number of sexual partners, level of partner contraceptive involvement, and any partner objections. A woman’s willingness to touch her genitals and cervical mucus is a key factor for the nurse to discuss only if the client expresses interest in using one of the fertility awareness methods of contraception.

Question 40

A woman taking an oral contraceptive pill (OCP) as her birth control method of choice should notify her health care provider immediately if she notes:
A. Breast tenderness and swelling
B. Weight gain
C. Swelling and pain in one of her legs
D. Mood swings

Answer 40

Ans: C
Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. Breast tenderness and weight gain are expected side effects of OCPs, and mood swings are a common side effect.

Question 41

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

Answer 41

Ans: D
Sterilization procedures can be safely done on an outpatient basis. Complications are uncommon and usually not serious. The average failure rate for female sterilization is 0.5% and for male sterilization is 0.15%. A vasectomy has no effect on potency or volume of ejaculate. Sterilization reversal is costly, difficult, and uncertain.

Question 42

If used consistently and correctly, which of the barrier methods of contraception has the lowest failure rate?
 A. Spermicides
  B. Female condoms
  C. Male condoms 
 D.  Diaphragms

Answer 42

Ans: C
For typical users, the failure rate for male condoms may approach 15%; however, if condoms are used correctly, the failure rate is only 2%. Failure rates are about 29% for spermicides, about 21% for female condoms, and 16% for diaphragms with spermicides.