Question 1

Obese women may have increased risk of failure with which contraceptive method?&#10;A)Combined oral contraceptives&#10;B)Progestin-only oral contraceptive pill&#10;C)Injectable progestin&#10;D)Combined topical patch&#10;

Accepted Answer

Obese women may have an increased risk of failure with the combined topical patch contraceptive method. This is because the absorption of the hormones in the patch can be affected by body fat percentage, potentially leading to lower effectiveness in preventing pregnancy compared to women with lower body mass index (BMI).

Question 2

Adverse effects of depot medroxyprogesterone acetate (DMPA) (Depo-Provera) include:&#10;A)&#9;Decrease in bone mineral density with longer-term use&#10;B)&#9;Increase in migraines&#10;C)&#9;Increased risk for venous thromboembolism (VTE)&#10;D)&#9;Increased risk of cardiovascular events&#10;

Accepted Answer

Depot medroxyprogesterone acetate (DMPA) is associated with a decrease in bone mineral density with long-term use. This is a well-documented adverse effect, particularly concerning in adolescents and young women.

Question 3

Progesterone-only pills are recommended for women who:&#10;A)Are breastfeeding&#10;B)Have a history of migraine&#10;C)Have a medical history that contradicts the use of estrogen&#10;D)All of the above&#10;

Accepted Answer

Progesterone-only pills are suitable for women in all the mentioned situations: they are safe during breastfeeding, recommended for those with a history of migraines (especially migraines with aura, where estrogen-containing contraceptives are contraindicated), and are an alternative for those who cannot use estrogen due to various medical reasons.

Question 4

Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:

A)Recommend she return to the clinic at the start of her next menses to get a Depo- Provera shot.
B)Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first seven days.
C)Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first seven days.
D)Discuss the advantages of using the topical birth control patch and recommend she consider using it.

Accepted Answer

Starting oral contraceptives on the same day as the clinic visit (known as "quick start") is an accepted practice. It allows the patient to begin contraception immediately, reducing the risk of an unintended pregnancy. The recommendation to use a back-up method for the first seven days ensures contraceptive effectiveness while the oral contraceptives reach their full effect. This approach is supported by evidence and guidelines for initiating hormonal contraception.

Question 5

Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of:&#10;A)Hemoglobin&#10;B)Serum calcium&#10;C)White blood count&#10;D)Serum potassium&#10;

Accepted Answer

Drospirenone, a synthetic progestin found in some oral contraceptives, can cause an increase in serum potassium levels. This is due to its antimineralocorticoid properties, which can lead to the retention of potassium. Therefore, women taking oral contraceptives containing drospirenone may require monitoring of their serum potassium levels to prevent hyperkalemia.

Question 6

A contraindication to the use of combined contraceptives is:&#10;A)Adolescence (not approved for this age)&#10;B)A history of clotting disorder&#10;C)Recent pregnancy&#10;D)Being overweight&#10;

Accepted Answer

A history of clotting disorder is a contraindication to the use of combined contraceptives because they can increase the risk of thromboembolic events.

Question 7

The topical patch combined contraceptive (Ortho Evra) is:&#10;A)Started on the first day of the menstrual cycle&#10;B)Recommended for women over 200 pounds&#10;C)Not as effective as oral combined contraceptives&#10;D)Known to have more adverse effects, such as nausea, than the oral combined contraceptives&#10;

Accepted Answer

The Ortho Evra patch is typically started on the first day of the menstrual cycle to ensure immediate contraceptive protection.

Question 8

Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?&#10;A)Increased migraine headaches&#10;B)Increased risk of developing blood clots&#10;C)Irregular vaginal bleeding for the first few months&#10;D)Increased risk for hypercalcemia&#10;

Accepted Answer

Progestin-only contraception is commonly associated with irregular vaginal bleeding, especially during the first few months of use.

Question 9

To improve actual effectiveness of oral contraceptives women should be educated regarding:&#10;A)Use of a back-up method if they have vomiting or diarrhea during a pill packet&#10;B)Doubling pills if they have diarrhea during the middle of a pill pack&#10;C)The fact that they will have a normal menstrual cycle if they miss two pills&#10;D)The fact that mid-cycle spotting is not normal and the provider should be contacted immediately&#10;

Accepted Answer

A) Women should be educated about using a backup method if they experience vomiting or diarrhea during a pill packet because these conditions can interfere with the absorption of the contraceptive, potentially reducing its effectiveness.

Question 10

Oral emergency contraception (Plan B) is contraindicated in women who:&#10;A)Had intercourse within the past 72 hours&#10;B)May be pregnant&#10;C)Are taking combined oral contraceptives&#10;D)Are using a diaphragm&#10;

Accepted Answer

Plan B (levonorgestrel) is contraindicated in women who are already pregnant because it is intended to prevent pregnancy and has no effect if a woman is already pregnant. It does not terminate an existing pregnancy.

Question 11

When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:&#10;A)Immediate protection against pregnancy the first week of using the pill&#10;B)No back-up method is needed when starting&#10;C)Menses occur during the week&#10;D)They can start the pill on the Sunday after the office visit&#10;

Accepted Answer

The answer of When discussing with a patient the different...

Question 12

The mechanism of action of oral combined contraceptives that prevents pregnancy is:&#10;A)Estrogen prevents the luteinizing hormone surge necessary for ovulation.&#10;B)Progestins thicken cervical mucus and slow tubal motility.&#10;C)Estrogen thins the endometrium making implantation difficult.&#10;D)Progestin suppresses follicle stimulating hormone release.&#10;

Accepted Answer

The answer of The mechanism of action of oral combined...

Question 13

An advantage of using the NuvaRing vaginal ring for contraception is:&#10;A)It does not require fitting and is easy to insert.&#10;B)It is inserted once a week, eliminating the need to remember to take a daily pill.&#10;C)Patients get a level of estrogen and progestin equal to combined oral contraceptives.&#10;D)It also provides protection against vaginal infections.&#10;

Accepted Answer

The answer of An advantage of using the NuvaRing vaginal...

Deck 33: Contraception