Maternity & Women’s Health Care 10th Edition by Kathryn Rhodes – ‎ Deitra Leonard Lowdermilk

Maternity & Women’s Health Care 10th Edition by Kathryn Rhodes – ‎ Deitra Leonard Lowdermilk

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

Chapter 08: Contraception and Abortion

Test Bank

MULTIPLE CHOICE

1. A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse:
a. Obtain a history of 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 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 it is not the most important aspect to assess for discussion of the calendar method.

DIF: Cognitive Level: Analysis REF: 172
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

2. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurse’s most appropriate reply is:
a. “They’re not very effective, and it’s very likely you’ll get pregnant.”
b. “They can be effective for many couples, but 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.
Fertility awareness methods are effective if used correctly by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 25% 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: Application REF: 172
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

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. The nurse’s most appropriate response would be:
a. “This is a highly effective method, but it has some side effects.”
b. “Your current medications will reduce the effectiveness of the pill.”
c. “The pill will reduce the effectiveness of your seizure medication.”
d. “This is a good choice for a woman of your age and personal history.”

ANS: B
Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants.
Stating that the pill is an effective birth control method with side effects is a true statement, but it is not the most appropriate response.
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: Application REF: 182
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

4. A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, she should be advised to:
a. Avoid sexual contact for at least 10 days after starting the pill
b. Use condoms and foam for the first few weeks as 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 contraceptives are to be started within 3 weeks after an abortion, another method of contraception should be used throughout the first week to avoid the risk of pregnancy.
If contraceptives are to be started within 3 weeks after an abortion, another method of contraception should be used throughout the first week to avoid the risk of pregnancy.
Additional forms of contraception should be used for 1 week after starting on oral contraceptives.
If contraceptives are to be started within 3 weeks after an abortion, another method of contraception should be used throughout the first week to avoid the risk of pregnancy.

DIF: Cognitive Level: Comprehension REF: 181
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

5. Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who:
a. Want menstrual regularity and predictability
b. Have a history of thrombotic problems or breast cancer
c. Have difficulty remembering to take oral contraceptives daily
d. Are homeless or mobile and rarely receive health care

ANS: C
Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year.
Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding.
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: Comprehension REF: 184
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

6. A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurse’s most appropriate response is:
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 safely be 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. No additional spermicide is required for repeated acts of intercourse.
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: Application REF: 180
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

7. Postcoital contraception with Ovral:
a. Requires that the first dose be taken within 120 hours of unprotected intercourse
b. Requires that the woman take second and third doses at 24 and 36 hours after the first dose
c. Has an effectiveness rate in preventing pregnancy of approximately 50%
d. Is commonly associated with the side effect of menorrhagia

ANS: A
Emergency contraception is used within 120 hours of unprotected intercourse to prevent pregnancy.
The first dose of an emergency contraception should be taken within 120 hours after coitus.
Postcoital use of Ovral is 74% to 90% effective at preventing pregnancy.
The common side effect of postcoital contraception is nausea.

DIF: Cognitive Level: Comprehension REF: 184
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

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). The nurse’s most appropriate response is:
a. “The IUD does not interfere with sex.”
b. “The risk of pelvic inflammatory disease will be higher for you.”
c. “The IUD will protect you from sexually transmitted infections.”
d. “Pregnancy rates are high with the IUDs.”

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). Because this woman has multiple sex partners, she is at higher risk of developing an STI. The IUD does not protect against infection, as does a barrier method.
Stating that an IUD does not interfere with sex may be correct, it is not the most appropriate response.
The IUD offers no protection from STIs.
The typical failure rate of the IUD ranges from 0.8% to 2%.

DIF: Cognitive Level: Application REF: 185
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

9. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is:
a. Administration of prostaglandins
b. Instillation of hypertonic saline into the uterine cavity
c. IV administration of Pitocin
d. Vacuum aspiration

ANS: A
The most common technique for medical termination of a pregnancy in the second trimester is administration of prostaglandins.
Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use.
IV administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise.
Vacuum aspiration is used for abortions in the first trimester.

DIF: Cognitive Level: Comprehension REF: 191
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation

10. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by:
a. Limiting sexual contact for one cycle after starting the pill
b. Using condoms and foam instead of the pill for as long as she takes an antibiotic
c. Taking one pill at the same time every day
d. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle

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 abortion, 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, she should take two pills a day for 2 days and finish the package and use a backup method the next 7 consecutive days.

DIF: Cognitive Level: Application REF: 181
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

11. A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her “fertile” time. She asks the nurse about emergency contraception. The nurse would tell her that:
a. It is too late; she needed to begin treatment within 24 hours after intercourse
b. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy
c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting
d. The most effective approach is to use a progestin-only preparation

ANS: C
To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose.
Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy.
Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy.
Oral emergency contraceptive regimens may include progestin-only and estrogen-progestin pills. Women with contraindications to estrogen use should use progestin-only pills.

DIF: Cognitive Level: Analysis REF: 184
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

12. Although reported in small numbers, toxic shock syndrome can occur with the use of a diaphragm. If a client is interested in this form of conception control, the nurse should teach the woman how to reduce her risk of TSS. The nurse might say:
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 38.4º 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.”

ANS: A
The nurse should instruct the client on 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.
The diaphragm needs to 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.

DIF: Cognitive Level: Application REF: 180
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

13. The conscious decision on when to conceive or avoid pregnancy throughout the reproductive years is called:
a. Family planning
b. Birth control
c. Contraception
d. Assisted reproductive therapy

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.

DIF: Cognitive Level: Knowledge REF: 169
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

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 “babies.”
b. R stands for “reproduction.”
c. A stands for “alternatives.”
d. I stands for “ineffective.”

ANS: C
A stands for alternatives, or information about other viable methods.
B stands for benefits, or information about advantages and success rates.
R stands for risks, or information about disadvantages and failure rates.
I stands for inquiries, or the opportunity to ask questions.

DIF: Cognitive Level: Knowledge REF: 170
OBJ: Client Needs: Safe and Effective Care Environment
TOP: Nursing Process: Diagnosis

15. What is not a potential pitfall or disadvantage of the fertility awareness methods (FAMs)?
a. Adherence to strict record keeping
b. Alterations in the menstrual flow pattern with chemicals and hormones
c. Decreased effectiveness in women with irregular cycles
d. Time-consuming training sessions

ANS: B
The absence of chemicals or hormones to alter the menstrual flow is an advantage.
The strict record keeping FAMs require creates a potential risk.
FAMs are less effective for women with irregular cycles.
FAMs require time-consuming training for effective use.

DIF: Cognitive Level: Comprehension REF: 172
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

16. While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning:
a. Is the same as coitus interruptus, or “pulling out”
b. Uses the calendar method to align the woman’s cycle with the natural phases of the moon
c. Is the only contraceptive practice acceptable to the Roman Catholic Church
d. Relies on barrier methods during fertility phases

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.

DIF: Cognitive Level: Comprehension REF: 171
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

17. Which contraceptive method has a failure rate of less than 25%?
a. Standard days
b. Periodic abstinence
c. Postovulation
d. Coitus interruptus

ANS: A
The standard days variation on the calendar method has a failure rate of 12%.
The periodic abstinence method has a failure rate of 25% or higher. The standard days variation on the calendar method has a failure rate of 12%.
The postovulation method has a failure rate of 25% or higher.
The coitus interruptus method has a failure rate of 27% or higher.

DIF: Cognitive Level: Knowledge REF: 172
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

18. Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)?
a. Periodic abstinence
b. Barrier methods
c. Hormonal methods
d. They all offer about the same protection.

ANS: B
Barrier methods, such as condoms, best protect against STIs and HIV.
Periodic abstinence offers no protection against STIs or HIV.
Hormonal methods, such as birth control pills, offer no protection against STIs or HIV.
Periodic abstinence and hormonal methods (“the pill”) offer no protection against STIs or HIV.

DIF: Cognitive Level: Application REF: 175
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

19. With regard to the noncontraceptive medical effects of combination oral contraceptives (COCs), nurses should be aware that:
a. COCs can cause toxic shock syndrome if the prescription is wrong
b. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week
c. COCs increase the risk of endometrial and ovarian cancer
d. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements

ANS: D
The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.
Toxic shock syndrome can occur in some diaphragm users, 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.

DIF: Cognitive Level: Comprehension REF: 182
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

20. With regard to the use of intrauterine devices (IUDs), nurses should be aware that:
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 sexually transmitted infections as the diaphragm
d. Consent forms are not needed for IUD insertion

ANS: B
The woman has up to 5 days to insert the IUD after unprotected sex.
Return to fertility is immediate after removal of the IUD.
IUDs offer no protection for sexually transmitted infections.
A consent form is required for insertion, as is a negative pregnancy test.

DIF: Cognitive Level: Knowledge REF: 185
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

21. Which statement is the most complete and accurate description of medical abortions?
a. They are performed only for maternal health.
b. They can be achieved through surgical procedures or with drugs.
c. They are mostly performed in the second trimester.
d. They can be either elective or therapeutic.

ANS: D
Abortions can be either elective (the woman’s choice) or therapeutic (for reasons of maternal or fetal health).
Abortions might be performed for maternal health or because of the woman’s choice.
Medical abortions are performed through the use of medications (rather than surgical procedures).
Medical abortions are usually performed in the first trimester.

DIF: Cognitive Level: Comprehension REF: 191
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

1. You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out? Choose all that apply.
a. “It is highly unlikely that you will become pregnant after the procedure.”
b. “This is an effective form of 100% permanent sterilization. You won’t be able to get pregnant.”
c. “Sterilization offers some form of protection against sexually transmitted infections.”
d. “Sterilization offers no protection against sexually transmitted infections.”
e. “Your menstrual cycle will greatly increase after your sterilization.”

ANS: A, D
A woman is unlikely to become pregnant after tubal ligation. Sterilization offers no protection against sexually transmitted infections (STIs).
Tubal ligation is not 100% effective. Tubal ligation does not offer any protection against STIs. Typically, the menstrual cycle remains the same after a tubal ligation.

DIF: Cognitive Level: Application REF: 187
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

COMPLETION

1. The ________________ _______________ _________________ (LAM) can be a highly effective, temporary method of birth control.

ANS:
Lactation amenorrhea method
This method is more popular in undeveloped countries and traditional societies where breastfeeding is used to prolong pregnancy intervals. Most American women do not establish breastfeeding patterns that provide maximum protection from pregnancy.

DIF: Cognitive Level: Application REF: 189
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning