Question 1

A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to:

Accepted Answer

If one or two pills are missed during the second or third week of a 28-day cycle, the patient should be instructed to take one pill as soon as possible, continue the pack, skip the placebo pills, and go straight to a new pack. It is not necessary to use an alternative form of contraception. If three or more pills are missed, the risk of pregnancy increases.

Question 2

A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it:

Accepted Answer

Mifepristone is most effective if it is used within 7 weeks of conception. The timing specified in the other responses is incorrect.

Question 3

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider?

Accepted Answer

This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her; patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and should not be used by young women, because it is irreversible. Progestin-only oral contraceptives must be taken every day.

Question 4

A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what?

Accepted Answer

When changing one combination OC for another, the change is best made at the beginning of a new cycle. It is not correct to begin taking the new product immediately; to stop the old product 1 week before starting the new product; or to use an alternate method of birth control between regimens.

Question 5

A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works?

Accepted Answer

When a patient taking a progestin-only OC misses one or more pills, backup contraception should always be used for at least 2 days. Irregular bleeding occurs but is not an indication to stop using the drug, although many women do because of the inconvenience. The mini-pill is slightly safer than combination OCs but not as effective. The minipill is a weak inhibitor of ovulation.

Question 6

A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to:

Accepted Answer

Spermicides that contain nonoxynol-9 have been linked to the increased transmission of HIV. Spermicides containing nonoxynol-9 have not been linked to HPV infections, spontaneous abortions, or endometrial cancer.

Question 7

A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend?

Accepted Answer

Breast tenderness, edema, and nausea are associated with estrogen; women experiencing these side effects may benefit from an OC with a lower estrogen dose. Lowering the progestin will not decrease these symptoms. It is not necessary to change birth control methods if side effects can be managed by altering the estrogen dose. Taking the OC at bedtime will not affect the symptoms.

Question 8

A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient?

Accepted Answer

When beginning oral contraceptives, it is important that the patient use another form of contraception for the first month, because protection is not immediate. Breakthrough spotting is common and is not an indication for starting a new cycle. Protection from pregnancy is not immediate. It is important to take the pills at the same time each day.

Question 9

A patient asks about the effectiveness of various birth control methods. The nurse should inform her that the most effective methods are what?

Accepted Answer

The most effective methods of birth control are IUDs, intramuscular medroxyprogesterone acetate [Depo-Provera], implants, and sterilization. Spermicides are not one of the most effective methods of birth control.

Question 10

A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?

Accepted Answer

Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs. Monogamous married women are less apt to contract STDs. Women with rosacea can use an IUD.

Question 11

A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to:

Accepted Answer

If a ring is expelled before 3 weeks have passed, it can be reinserted after being washed in warm water. If the ring has been out longer than 3 hours, backup contraception should be used for 7 days. Because this ring was expelled while the patient was sleeping, using backup contraception is prudent. Discarding the ring is not indicated if it can be cleaned. The ring should not be washed in hot water.

Question 12

A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do?

Accepted Answer

To ensure that patients are not pregnant when they receive DMPA, the first injection should be given during the first 5 days of a normal menstrual period.

Question 13

A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring:

Accepted Answer

When patients who have been using a progestin-only OC begin using a vaginal ring, they should be instructed to insert the ring on the last day of the pill and use backup contraception for 7 days.

Question 14

A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest?

Accepted Answer

OC users can achieve an extended-cycle schedule by discarding the inert pills and beginning a new pack for up to four cycles. It is not necessary to discontinue OCs. Because this woman has already purchased a 1-year supply, using the 28-day-cycle product as described is appropriate. If this woman opts for a long-term product, she should discontinue the OC.

Question 15

A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient?

Accepted Answer

Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The estrogen-containing OC should be stopped 4 weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.

Question 16

A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do?

Accepted Answer

Carbamazepine induces hepatic cytochrome P450 and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced OC blood levels; patients experiencing this symptom may need an increased estrogen dose. If the dose of OC is not changed, the woman may use condoms along with the OC. Reducing the dose of carbamazepine is not correct. Discontinuing the OC immediately is not correct.

Question 17

A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will:

Accepted Answer

Patients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen. A pregnancy test is not indicated. It is not necessary to use a backup form of contraception.

Quiz 62: Birth Control