Contraception and Family Planning Nursing Exam

Correct Answer B: Depo-Provera injection

Explanation:

Depo-Provera (medroxyprogesterone acetate) is a progestin-only injectable contraceptive administered once every 3 months, making it a suitable low-maintenance option for women who struggle with daily pill adherence. It is highly effective and reversible.

Why the other options are incorrect:

A) Condoms:

While effective for STI prevention, condoms require use with each sexual act and are not considered a low-maintenance method.

C) Combined oral contraceptives:

These require daily administration, which the patient has already indicated is difficult for her.

D) Diaphragm:

This method must be inserted before each act of intercourse, which also does not meet the patient's request for a low-maintenance method.

Correct Answer D: Leiomyomas

Explanation:

Leiomyomas (uterine fibroids) are not a contraindication to hormonal contraceptives. In fact, hormonal contraceptives—particularly combined oral contraceptives or progestin-only methods—can help manage symptoms like heavy menstrual bleeding and pelvic pain caused by fibroids.

Why the other options are incorrect:

A) Cardiovascular disease:

Correct contraindication. Women with a history of thromboembolic events, stroke, or other cardiovascular conditions should avoid estrogen-containing contraceptives due to increased clotting risk.

B) Severe varicose veins:

Correct contraindication, especially if associated with venous insufficiency or thrombophlebitis. Estrogen can increase the risk of venous thromboembolism.

C) Severe myopia:

Correct in certain clinical contexts. While not a universal contraindication, severe or progressive myopia can be a relative concern, especially in the presence of retinal degenerative changes or vascular complications, which might be worsened by hormonal changes.

Correct Answer A: The procedure will be completed using an intravenous sedation and cervical block.

Explanation:

Egg retrieval for in vitro fertilization (IVF) is typically performed using transvaginal ultrasound-guided aspiration. The patient is usually given intravenous (IV) sedation and/or a cervical block to manage pain and discomfort. General anesthesia is not typically required, making the procedure minimally invasive and suitable for outpatient care.

Why the other options are incorrect:

B) The procedure will require a 2-day stay in the hospital for egg retrieval and embryo placement:

Incorrect. Egg retrieval is an outpatient procedure. Patients are usually discharged within a few hours after recovery from sedation. Embryo transfer is a separate procedure that occurs several days later and also does not require hospitalization.

C) No supplements will be needed after the procedure:

Incorrect. Many patients are prescribed supplements or medications post-procedure, such as progesterone to support the uterine lining and enhance the chances of implantation. Prenatal vitamins, including folic acid, are also commonly recommended.

D) Regular activity can be resumed after the procedure:

Incorrect. Patients are typically advised to rest for the remainder of the day following egg retrieval. While most can return to light activities the next day, strenuous activity should be avoided due to the risk of ovarian torsion or discomfort.

Correct Answer C: Increase daily fluid consumption

Explanation:

Increasing daily fluid intake helps flush bacteria from the urinary tract, reducing the risk of urinary tract infections (UTIs) such as cystitis. Adequate hydration promotes frequent urination, which helps clear the bladder and prevent bacterial growth.

Why the other options are incorrect:

A. Avoid regular use of tampons

While tampons can sometimes irritate the genital area, there is no strong evidence linking tampon use to increased risk of cystitis.

B. Decrease intake of prune juice

Prune juice is not related to the prevention or promotion of cystitis; it is often recommended to aid bowel movements.

D. Cleanse the perineum from back to front

This is incorrect and increases the risk of introducing bacteria from the anus to the urethra, promoting infection. The correct practice is to cleanse from front to back.

Correct Answer B: Diaphragms should not be used if the client develops acute cervicitis.

Explanation:

A diaphragm is a barrier contraceptive device that fits over the cervix and is used with spermicide to prevent pregnancy. If a client has acute cervicitis (inflammation or infection of the cervix), the diaphragm should not be used until the condition is treated and resolved. Using the diaphragm during an active cervical infection can cause irritation, delay healing, and potentially worsen the infection or allow it to ascend to the upper reproductive tract. The nurse should instruct the client to consult a healthcare provider if she experiences symptoms of cervicitis, such as abnormal discharge, cervical pain, or bleeding after intercourse.

Why the other options are incorrect:

A) Douching with an acidic solution after intercourse is recommended:

This is incorrect. Douching is not recommended as a method of contraception or postcoital care. It can disrupt the normal vaginal flora, increase the risk of pelvic infections, and is ineffective at preventing pregnancy.

C) The diaphragm should be washed in a weak solution of bleach and water:

This is incorrect and unsafe. Bleach can damage the material of the diaphragm, causing it to deteriorate. The diaphragm should be washed gently with mild soap and warm water, then air-dried and stored in a cool, dry place.

D) The diaphragm should be left in place for 2 hours after intercourse:

This is incorrect. The diaphragm must remain in place for at least 6 hours after intercourse to ensure that the spermicide has sufficient time to deactivate sperm. However, it should not be left in longer than 24 hours, as that increases the risk of toxic shock syndrome.

Correct Answer D: one week after the beginning of her period

Explanation:

The most appropriate time for a woman to perform a breast self-examination (BSE) is one week after the beginning of her menstrual period. At this point in the menstrual cycle, hormone levels—particularly estrogen and progesterone—are lower, leading to reduced swelling and tenderness in breast tissue. This makes it easier to detect any unusual lumps, thickening, or changes in the breast.

Why the other options are incorrect:

A. a few days before her period

This is typically when hormone levels are at their peak, causing the breasts to feel fuller, lumpier, or more tender. This can interfere with accurate assessment during self-examination.

B. during her menstrual period

Breast tissue may still be tender or swollen due to hormonal changes, which can make it uncomfortable or difficult to detect subtle changes.

C. on the last day of menstrual flow

Although closer to the ideal time than the other incorrect options, it does not allow enough time for hormonal influences to fully subside. Waiting a full week after menstruation begins provides more accurate conditions for BSE.

Correct Answer B: 1st and 3rd answers are correct

Explanation:

Estrogen in combined hormonal contraceptives has favorable effects on lipid metabolism:

 Increase plasma HDL level:

Correct. Estrogen raises HDL ("good cholesterol") levels, which is a protective cardiovascular effect.

 Decrease plasma HDL level:

Incorrect. Estrogen does not lower HDL; it actually increases it.

 Decrease plasma LDL level:

Correct. Estrogen helps lower LDL ("bad cholesterol") levels, contributing to better lipid profiles in some users.

Increase plasma LDL level:

Incorrect. Estrogen generally reduces, not increases, LDL levels.

Correct Answer A: For women with well known, regular cycle

Explanation:

Behavioral contraception methods, such as the calendar method, basal body temperature method, and cervical mucus monitoring, rely on accurately predicting ovulation to avoid unprotected sex during fertile periods. These methods are most reliable for women who have regular, predictable menstrual cycles, which allows for accurate tracking and timing.

Why the other options are incorrect:

B) In case of vaginal discharge:

Incorrect. Excessive or abnormal vaginal discharge can interfere with cervical mucus monitoring, making fertility tracking unreliable.

C) With irregular menstruational cycle:

Incorrect. Irregular cycles make it difficult to predict ovulation accurately, reducing the effectiveness of natural methods and increasing the risk of unintended pregnancy.

D) During lactational amenorrhea:

Incorrect. While lactational amenorrhea can serve as a temporary contraceptive method, it is not classified as a behavioral method. It has specific criteria and is considered a separate method based on physiology, not cycle tracking.

Correct Answer A: History of treatment for pelvic inflammatory disease (PID)

Explanation:

Pelvic Inflammatory Disease (PID) is a significant risk factor for infertility in women. It can lead to scarring and damage to the fallopian tubes, which may result in tubal factor infertility, ectopic pregnancy, or chronic pelvic pain. Because the couple has been trying to conceive for over a year without success, a history of PID requires further evaluation, such as imaging (e.g., hysterosalpingography) or referral to a fertility specialist.

Why the other options are less concerning:

B) History of sinusitis:

Sinusitis is unrelated to reproductive health and does not affect fertility. It is not a factor that would interfere with conception or the reproductive organs.

C) History of treatment for asthma:

While asthma should be well-controlled during pregnancy, it does not typically impact fertility. As long as the asthma is managed properly, it is not a barrier to conception.

D) History of breast augmentation:

Cosmetic breast augmentation does not affect fertility. It may be relevant during prenatal care or breastfeeding discussions but is not associated with difficulty conceiving.