Maternity & Women’s Health Care, 11th Edition
Chapter 08: Contraception and Abortion
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
MULTIPLE CHOICE
1. A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform ...
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Maternity & Women’s
Health Care, 11th
Edition
,Chapter 08: Contraception and Abortion
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
MULTIPLE CHOICE
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.
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.
DIF: Cognitive Level: Analyze REF: p. 174
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
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.‖
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.
DIF: Cognitive Level: Apply REF: pp. 173-174 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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.‖
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.
DIF: Cognitive Level: Apply REF: p. 184 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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.
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.
DIF: Cognitive Level: Apply REF: p. 193 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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.
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.
DIF: Cognitive Level: Understand REF: p. 186
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
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.‖
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.
DIF: Cognitive Level: Apply REF: p. 181 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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.
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.
DIF: Cognitive Level: Understand REF: p. 186
TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
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.‖
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%.
DIF: Cognitive Level: Apply REF: p. 187 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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?
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