Contraception and Family Planning Nursing Exam

Correct Answer C: Intrauterine device (IUD)

Explanation:

Intrauterine devices (IUDs), both copper and hormonal, generally have minimal or no impact on weight. The copper IUD is non-hormonal and does not influence weight, while the hormonal IUD releases low-dose progestin locally with minimal systemic effects.

Why the other options are incorrect:

A) Combined oral contraceptives:

May cause fluid retention and mild weight changes in some women, though evidence is mixed.

B) Progestin-only pill:

Some women report weight gain, but evidence is inconclusive.

D) Contraceptive implant:

May be associated with weight gain in some users due to systemic progestin effects.

Correct Answer c: As ovulation approaches, cervical mucus is abundant and clear.

Explanation:

Cervical mucus undergoes characteristic changes during the menstrual cycle influenced by hormonal fluctuations. As ovulation approaches, rising estrogen levels cause the cervical mucus to become thin, clear, stretchy, and abundant, resembling raw egg whites. This type of mucus facilitates sperm movement and survival, increasing fertility during the fertile window. Monitoring these mucus changes is a key component of fertility awareness methods.

Why the other options are incorrect:

a) About midway through the menstrual cycle, cervical mucus is thick and sticky:

This is incorrect. Mid-cycle, around ovulation, mucus is thin and stretchy, not thick and sticky. Thick and sticky mucus occurs during the luteal phase, after ovulation.

b) During ovulation, the cervix remains dry without any mucus production:

This is false. Ovulation is marked by increased mucus production that is clear and slippery, not dryness.

d) Cervical mucus disappears immediately after ovulation, resuming with menses:

This is inaccurate. After ovulation, cervical mucus becomes thicker and less abundant but does not disappear immediately. It typically becomes scant and sticky during the luteal phase before menstruation resumes.

Correct Answer A: Mosaicism

Explanation:

Mosaicism refers to a condition in which an individual has two or more genetically different cell lines that originated from a single fertilized egg. This occurs due to nondisjunction or other chromosomal errors after fertilization, during early embryonic mitotic cell divisions. Some cells carry the normal number of chromosomes, while others carry an abnormal number, such as an extra or missing chromosome.

For example, a person with mosaic Down syndrome may have some cells with the typical number of chromosomes and others with an extra copy of chromosome 21.

Why the other options are incorrect:

B) Trisomy 21:

This is the most common cause of Down syndrome, characterized by an extra copy of chromosome 21 in all cells of the body—not limited to some cells as in mosaicism.

C) Trisomy 13:

Also known as Patau syndrome, this involves an extra copy of chromosome 13 in all cells. It is a form of nondisjunction, but not mosaicism unless specifically noted.

D) Monosomy:

Monosomy refers to the absence of one chromosome from a pair (e.g., Turner syndrome is monosomy X). It describes a uniform chromosomal deletion, not a mixed cell line condition.

Correct Answer A: For women with well known, regular cycle

Explanation:

Behavioral contraception methods, such as the calendar method, basal body temperature method, and cervical mucus monitoring, rely on accurately predicting ovulation to avoid unprotected sex during fertile periods. These methods are most reliable for women who have regular, predictable menstrual cycles, which allows for accurate tracking and timing.

Why the other options are incorrect:

B) In case of vaginal discharge:

Incorrect. Excessive or abnormal vaginal discharge can interfere with cervical mucus monitoring, making fertility tracking unreliable.

C) With irregular menstruational cycle:

Incorrect. Irregular cycles make it difficult to predict ovulation accurately, reducing the effectiveness of natural methods and increasing the risk of unintended pregnancy.

D) During lactational amenorrhea:

Incorrect. While lactational amenorrhea can serve as a temporary contraceptive method, it is not classified as a behavioral method. It has specific criteria and is considered a separate method based on physiology, not cycle tracking.

Correct Answer B: Diaphragms should not be used if the client develops acute cervicitis.

Explanation:

A diaphragm is a barrier contraceptive device that fits over the cervix and is used with spermicide to prevent pregnancy. If a client has acute cervicitis (inflammation or infection of the cervix), the diaphragm should not be used until the condition is treated and resolved. Using the diaphragm during an active cervical infection can cause irritation, delay healing, and potentially worsen the infection or allow it to ascend to the upper reproductive tract. The nurse should instruct the client to consult a healthcare provider if she experiences symptoms of cervicitis, such as abnormal discharge, cervical pain, or bleeding after intercourse.

Why the other options are incorrect:

A) Douching with an acidic solution after intercourse is recommended:

This is incorrect. Douching is not recommended as a method of contraception or postcoital care. It can disrupt the normal vaginal flora, increase the risk of pelvic infections, and is ineffective at preventing pregnancy.

C) The diaphragm should be washed in a weak solution of bleach and water:

This is incorrect and unsafe. Bleach can damage the material of the diaphragm, causing it to deteriorate. The diaphragm should be washed gently with mild soap and warm water, then air-dried and stored in a cool, dry place.

D) The diaphragm should be left in place for 2 hours after intercourse:

This is incorrect. The diaphragm must remain in place for at least 6 hours after intercourse to ensure that the spermicide has sufficient time to deactivate sperm. However, it should not be left in longer than 24 hours, as that increases the risk of toxic shock syndrome.

Correct Answer B: Not be contacted, because treatment at the clinic is confidential

Explanation:

Most states have laws that allow minors to consent to testing and treatment for sexually transmitted infections confidentially, without parental notification. This confidentiality encourages adolescents to seek care without fear of disclosure, which is important for public health and individual wellbeing.

Why the other options are incorrect:

A. Need to know to sign a consent form for testing and treatment

Minors often have the legal right to consent to STI services independently, so parental consent is usually not required.

C. Be notified when the insurance company is billed for testing and treatment

Insurance billing may sometimes disclose services to policyholders (often parents), but many clinics provide options for confidential billing or sliding-scale fees to protect confidentiality.

D. Remain uninformed if the adolescent ensures that her sexual contacts will come for testing

Parental notification is not contingent on the adolescent’s assurance about partners. Confidentiality protects the adolescent regardless of partner notification.

Correct Answer A: candidiasis

Explanation:

Candidiasis, also known as a yeast infection, is caused by the overgrowth of Candida albicans. It typically presents with vaginal and vulvar inflammation, intense itching or burning, and a characteristic thick, white, “cottage cheese-like” vaginal discharge. It is not sexually transmitted, though sexual activity can sometimes trigger symptoms.

Why the other options are incorrect:

B. trichomoniasis

Incorrect. Trichomoniasis, caused by the parasite Trichomonas vaginalis, usually produces frothy, yellow-green discharge with a foul odor, and may cause vaginal irritation or a “strawberry cervix” on exam—not a cottage cheese-like discharge.

C. bacterial vaginosis

Incorrect. Bacterial vaginosis results from an imbalance in vaginal flora and is characterized by thin, gray or white discharge with a strong fishy odor, particularly after sex. It does not cause cottage cheese-like discharge.

D. Chlamydia

Incorrect. Chlamydia often causes no symptoms or may present with mild vaginal discharge and pelvic pain, but it does not cause thick, white discharge or vulvovaginal inflammation typical of candidiasis.

Correct Answers:

B) The client should avoid douches and vaginal deodorants

C) The presence of semen or contraceptive gels can impact the character of cervical mucous

D) The client should check the character of cervical mucous each day

Explanation:

The cervical mucous method, also known as the Billings Ovulation Method, is a fertility awareness-based method used either to achieve or avoid pregnancy. It involves observing and recording the changes in cervical mucous throughout the menstrual cycle to identify fertile days.

B) The client should avoid douches and vaginal deodorants:

Correct. These products can disrupt the natural balance and characteristics of cervical mucous, making it difficult to accurately assess fertility signs.

C) The presence of semen or contraceptive gels can impact the character of cervical mucous:

Correct. Semen, lubricants, and spermicidal gels can mimic or alter the consistency of cervical mucous, potentially leading to inaccurate interpretations of fertility status.

D) The client should check the character of cervical mucous each day:

Correct. Daily observation is essential for identifying patterns in mucous changes. During the fertile window, cervical mucous becomes clear, slippery, and stretchy—similar to raw egg whites—indicating peak fertility.

Why the other options are incorrect:

A) The client must simultaneously monitor body temperature:

Incorrect. Monitoring basal body temperature is part of a separate fertility awareness method, not required for the cervical mucous method. Some women choose to combine methods for greater accuracy, but it is not a necessary component of cervical mucous tracking.

E) It is safe to have intercourse when cervical mucous reaches a dry, crumbly stage:

Incorrect. A dry, crumbly stage indicates infertile days and is not the optimal time to conceive. The most fertile period is when mucous is clear, wet, and stretchy. However, this choice is misleading—“safe” in this context might refer to pregnancy prevention, not conception, and could confuse the client.

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.