Contraception and Family Planning Nursing Exam

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

Explanation:

Clomiphene citrate is a selective estrogen receptor modulator (SERM) that works by blocking estrogen receptors in the hypothalamus, leading to increased secretion of GnRH, which then stimulates FSH and LH production to induce ovulation.

1) Anovulation form of PCO (Polycystic Ovary Syndrome):

Correct. Clomiphene is the first-line treatment for inducing ovulation in women with PCOS who experience anovulation.

2) Hypoprolactinaemia:

Incorrect. Clomiphene is not used in hypoprolactinaemia. This condition is rare and not typically a cause of infertility; in contrast, hyperprolactinaemia is more common and would be treated with dopamine agonists like bromocriptine or cabergoline, not clomiphene.

3) Luteal phase defect:

Correct. While not the primary treatment, clomiphene may be used to stimulate ovulation and help regulate luteal phase function in some cases, though progesterone supplementation is more commonly used.

4) Abnormal cervical factor:

Incorrect. Clomiphene can actually worsen cervical mucus quality by reducing its receptivity, making it unsuitable for treating cervical factor infertility.

Correct Answer C: I will need to use other methods of protection while taking antibiotics

Explanation:

Some antibiotics—particularly rifampin and rifabutin—are known to reduce the effectiveness of combined oral contraceptive pills (COCs) by altering hormone levels through liver enzyme induction. Although most common antibiotics prescribed for upper respiratory infections (e.g., amoxicillin, azithromycin) do not significantly interfere with birth control, it is still best practice to recommend using backup contraception during antibiotic use, as effectiveness could be reduced due to illness, gastrointestinal side effects (like vomiting or diarrhea), or possible drug interaction.

Why the other options are incorrect:

A) I will need to stop the birth control and use other protection while using the antibiotics because they interact with each other.

Stopping birth control is unnecessary. The correct action is to continue taking birth control as prescribed and use a backup method (like condoms) during the course of antibiotics and for a short time after. Discontinuing the birth control entirely is not advised.

B) I do not have to worry because antibiotics don’t interfere with oral birth control pills like they would with the monthly shot

This is an incorrect assumption. While most antibiotics do not interfere, some can reduce contraceptive effectiveness, and gastrointestinal illness caused by antibiotics may affect absorption. The monthly shot (e.g., Depo-Provera) is not typically affected by antibiotics, but this does not mean oral contraceptives are entirely unaffected.

D) I can not have intercourse while taking antibiotics.

There is no medical restriction against having intercourse while taking antibiotics. The concern is about contraceptive effectiveness—not abstinence. The focus should be on using backup protection, not avoiding sex altogether.

Correct Answer B: should be left in place for at least 6 hours after intercourse

Explanation:

For the diaphragm to be effective, it must be used with spermicidal cream or jelly and left in place for at least 6 hours after intercourse to ensure sperm are immobilized and unable to reach the uterus. However, it should not remain in place for more than 24 hours to reduce the risk of infection, particularly toxic shock syndrome.

Why the other options are incorrect:

A. does not require the use of a spermicidal cream or jelly with it

Incorrect. The diaphragm must be used with spermicide to be effective. The spermicide kills sperm while the diaphragm acts as a barrier.

C. is removed immediately after intercourse for douching

Incorrect. Removing the diaphragm immediately increases the risk of pregnancy, and douching is not recommended as it can disrupt the vaginal flora and increase the risk of infections.

D. is effective for up to 48 hours if positioned properly

Incorrect. The diaphragm is not effective for 48 hours. It should be removed within 24 hours, and if intercourse occurs again, additional spermicide should be applied without removing the diaphragm.

Correct Answer A: Oral progestin-only contraceptives stop or delay ovulation by thickening the cervical mucus and making the endometrium less receptive to implantation.

Explanation:

Emergency contraception (EC) is a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure. Oral progestin-only EC pills (like levonorgestrel, e.g., Plan B One-Step) work primarily by:

Delaying or inhibiting ovulation, so that the egg is not released.

Thickening cervical mucus, which helps block sperm from reaching the egg.

Altering the endometrial lining, making it less receptive to a fertilized egg, though this is not the primary mechanism.

These pills are most effective when taken within 72 hours, but can still have some effect up to 5 days after intercourse.

Why the other options are incorrect:

B) Oral progestin-only contraceptives must be taken within 48 hours of intercourse to induce rejection of the ovum:

Incorrect. Emergency contraception is most effective within 72 hours, not 48, and does not work by inducing rejection of a fertilized ovum. It does not disrupt an existing pregnancy or function as an abortifacient.

C) The Mirena intrauterine system (IUS) will prevent implantation if implanted within 12 hours after intercourse:

Incorrect. The Mirena IUS is not used for emergency contraception. The copper IUD (e.g., ParaGard) is the intrauterine method approved for EC and can be effective up to 5 days after intercourse. The copper IUD creates an inhospitable environment for sperm and possibly prevents implantation.

D) Emergency contraception works by preventing implantation of a fertilized ovum by causing a debridement effect on the uterus, sloughing off endometrial cells:

Incorrect and misleading. EC does not cause uterine debridement or sloughing in that manner. Its primary action is preventing ovulation. It does not terminate an established pregnancy and is not an abortive agent.

Correct Answer C: include more dairy products and green, leafy vegetables in her diet

Explanation:

Dairy products and green, leafy vegetables are excellent sources of calcium and vitamin D, both of which are essential for maintaining bone strength and preventing osteoporosis. Adequate intake of these nutrients helps reduce bone loss and supports overall bone health, particularly in women who are at higher risk due to hormonal changes with aging.

Why the other options are incorrect:

A. take a vitamin E supplement daily

Vitamin E is an antioxidant but does not play a direct role in bone health or osteoporosis prevention. Calcium and vitamin D are the primary nutrients involved.

B. do isometric exercises that can be practiced every day

While exercise is important for bone health, weight-bearing and resistance exercises (like walking, jogging, or strength training) are more effective than isometric exercises for stimulating bone formation.

D. try to limit her intake of caffeine

Excessive caffeine intake may slightly reduce calcium absorption, but this is a secondary consideration. The more impactful recommendation is to increase dietary calcium and vitamin D through appropriate foods.

Correct Answer  A: 1st, 2nd and 3rd answers are correct

Explanation:

Spotting (breakthrough bleeding) during oral contraceptive (OC) use is common, especially in the first few months of starting the pill. Several physiological and external factors can disrupt the hormone levels and lead to spotting.

1) Pill administration failure:

Correct. Missing pills or taking them at inconsistent times can cause hormonal fluctuations, which is a leading cause of spotting.

2) Drug interaction:

Correct. Certain medications (e.g., antibiotics, anticonvulsants, or St. John's Wort) can interfere with hormone metabolism and reduce the effectiveness of OCs, causing bleeding.

3) Absorption abnormalities:

Correct. Gastrointestinal conditions such as vomiting, diarrhea, or malabsorption syndromes can affect how the pill is absorbed, leading to hormonal instability and spotting.

4) Psychogenic stress:

Incorrect. While stress can affect the menstrual cycle in general, it is not a primary or common cause of spotting specifically associated with oral contraceptive use.

Correct Answer A: The doctor will perform a dilation and curettage (D&C)

Explanation:

In the first trimester, the most common surgical method for terminating a pregnancy is dilation and curettage (D&C) or more specifically, dilation and suction curettage. This procedure involves dilating the cervix and using gentle suction and/or a curette to remove the products of conception. This is a safe and commonly used method during the early weeks of pregnancy.

Why the other options are incorrect:

B) Medical interruption of pregnancy poses no serious risks.

Incorrect. Medical abortion (e.g., with mifepristone and misoprostol) is generally safe, but not risk-free. Risks can include incomplete abortion, heavy bleeding, infection, and adverse reactions. Saying it poses “no serious risks” reflects a lack of understanding.

C) I will take two medications for this procedure, one to change the endometrium and one to expel the fetus.

Incorrect for this scenario. This describes a medical abortion, not a surgical one. While accurate for pharmacological interruption, it is not relevant to a surgical procedure like D&C.

D) Waiting may be preferred, because surgical abortion in the second trimester is safer than in the first trimester.

Incorrect. Surgical abortion is safer in the first trimester. Risks increase with gestational age, making early intervention safer and more effective. Delaying the procedure increases both medical and emotional risks. 

Correct Answer B: This must be so difficult for you. Children are really important to you?

Explanation:

Option B demonstrates empathy and active listening. It acknowledges the patient's emotional distress and invites her to express her feelings, especially about her desire for children. This response supports therapeutic communication and helps the nurse build rapport, providing emotional support in a difficult situation.

Why the other options are incorrect:

A. There are so many orphans looking for a mother.

Insensitive and dismissive of the patient's feelings. It minimizes her loss and does not provide emotional support.

C. You really have no choice but to follow the recommendation; the doctor is right.

This is authoritative and dismissive. It denies the patient autonomy and does not validate her feelings or concerns.

D. Believe me when I tell you that kids are so difficult to raise—you're better off without them.

Insensitive and inappropriate. This statement invalidates the patient's feelings and may increase her distress.

Correct Answer A: The patient will correctly describe treatment options, including the risks and benefits of each.

Explanation:

A nursing outcome should be specific, measurable, achievable, and within the scope of nursing care. Ensuring that the patient can accurately describe treatment options, along with their risks and benefits, reflects comprehension, informed decision-making, and active participation in care—all central goals of nursing education and support during fertility treatment.

This outcome is realistic and allows the nurse to evaluate the patient’s understanding and readiness to proceed with care.

Why the other options are incorrect or less appropriate:

B) The patient will overcome the impact of infertility on personal relationships and lifestyle:

This is a broad and emotionally complex outcome that may be unrealistic in the short term and difficult to measure. It’s also outside the full scope of what nursing alone can address, often requiring counseling or therapy.

C) The patient will successfully complete in vitro fertilization treatment:

This is a medical outcome, not a nursing one. IVF success is influenced by multiple medical factors beyond the nurse’s control. Nursing outcomes should focus on education, coping, and patient behaviors—not treatment success.

D) The patient will repair personal relationships and social interactions:

While relationship support is important, this outcome is too vague and subjective, and difficult for the nurse to measure or facilitate alone. Support may be offered, but this goal requires collaborative, long-term psychosocial intervention.