Contraception and Family Planning Nursing Exam

Correct Answer A: Tell me about your usual sexual habits, outside of trying to conceive.

Explanation:

Infertility treatments can place significant emotional and physical stress on a couple’s sexual relationship. By asking open-ended, nonjudgmental questions like, “Tell me about your usual sexual habits, outside of trying to conceive,” the nurse:

Normalizes the conversation about sexuality

Encourages trust and openness

Helps the couple reflect on how intimacy may have shifted from emotional connection to goal-oriented behavior

This approach is supportive and holistic, recognizing that sexual health is more than reproductive function.

Why the other options are less appropriate:

B) What sexual dysfunctions are occurring?

This is too direct and clinical, and may make the patient feel defensive or embarrassed. It labels the issue as a dysfunction without first exploring their experience.

C) Can you explain back to me the cause of the infertility?

This tests knowledge rather than promotes sexual or emotional support. It may make the couple feel blamed or inadequate and does not address their sexual well-being.

D) What efforts have you put into improving sexual function?

This may come across as accusatory or critical, implying the couple hasn’t done enough. It also puts responsibility on the patient without first understanding their experience.

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

Explanation:

Estrogen in combined hormonal contraceptives has favorable effects on lipid metabolism:

 Increase plasma HDL level:

Correct. Estrogen raises HDL ("good cholesterol") levels, which is a protective cardiovascular effect.

 Decrease plasma HDL level:

Incorrect. Estrogen does not lower HDL; it actually increases it.

 Decrease plasma LDL level:

Correct. Estrogen helps lower LDL ("bad cholesterol") levels, contributing to better lipid profiles in some users.

Increase plasma LDL level:

Incorrect. Estrogen generally reduces, not increases, LDL levels.

Correct Answers:

B) Maintaining a healthy weight for your height is important for both partners.

C) Even if you do not want to have children now, it is helpful to discuss future goals with your partner.

E) There are many different methods of birth control; you can choose which fits your lifestyle and plan.

Explanation:

B) Maintaining a healthy weight for your height is important for both partners.

Correct. A healthy body weight contributes to fertility and reduces the risk of pregnancy complications such as gestational diabetes and hypertension. In men, a healthy weight also supports sperm quality and reproductive health.

C) Even if you do not want to have children now, it is helpful to discuss future goals with your partner.

Correct. Preconception counseling includes life planning and relationship communication. Discussing reproductive goals helps individuals or couples align their decisions with their values, lifestyle, and health considerations—even if pregnancy is not immediate.

E) There are many different methods of birth control; you can choose which fits your lifestyle and plan.

Correct. Contraceptive counseling is a key part of preconception planning. Understanding available options empowers individuals or couples to prevent unintended pregnancy until they are ready to conceive.

Why the other options are incorrect:

A) Preconception counseling must be started at least 6 months before attempting to conceive.

Incorrect. While earlier is often better, there is no strict rule that preconception counseling must begin 6 months prior. Counseling can be beneficial at any point before conception and should be individualized based on health needs and personal readiness.

D) Once you become pregnant, it will be helpful to start working on good exercise habits.

Incorrect. Healthy habits, including exercise, should ideally begin before pregnancy, not after. Establishing routines beforehand improves overall fitness, prepares the body for pregnancy, and helps sustain those habits throughout gestation.

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 A: A decrease in temperature followed by an increase for several days

Explanation:

Basal body temperature (BBT) typically drops slightly just before ovulation and then rises sharply (about 0.5°F to 1.0°F) after ovulation due to increased progesterone secretion. This elevated temperature usually remains higher for several days until just before the next menstrual cycle begins. The pattern of a brief temperature dip followed by a sustained increase is a key indicator of ovulation.

Why the other options are incorrect:

B) An increase in temperature followed by a decrease for several days:

This pattern is the reverse of what occurs during ovulation; temperature rises after ovulation and stays elevated until menses.

C) A decrease in temperature that remains until menses begins:

Temperature typically rises after ovulation, not decreases.

D) A steadily increasing temperature over seven days:

The increase happens abruptly after ovulation, not as a steady climb over many days.

Correct Answer C: The statement is true, but the explanation is false

Explanation:

The statement is true: The use of oral contraceptives (OCs) is associated with a fourfold increase in the risk of deep vein thrombosis (DVT), particularly with combined estrogen-progestin pills.

The explanation is false: It is not the progestin, but the estrogen component (usually ethinyl estradiol) that is primarily responsible for increasing the risk of thrombosis. Estrogen increases the hepatic synthesis of clotting factors, reduces anticoagulant proteins, and enhances thrombin generation, thereby raising the risk of thromboembolic events.

Why the other options are incorrect:

A) Both true with causal link:

Incorrect. The cause given (progestin) is incorrect.

B) Both true, no causal link:

Incorrect. The explanation is false, so this option is invalid.

D) Statement false, explanation true:

Incorrect. The explanation is false; progestin alone does not significantly increase thrombosis risk.

E) Both false:

Incorrect. The increased DVT risk with OCs is well established.

Correct Answer C: Being aware of the client’s cultural and religious beliefs

Explanation:

Cultural and religious beliefs play a significant role in a client’s values, attitudes, and decisions about sexuality, contraceptive use, and healthcare in general. The nurse should approach the conversation with cultural sensitivity, avoid assumptions, and create a respectful and nonjudgmental environment that supports open communication. Being aware of and respecting the client’s cultural context helps build trust and ensures more effective care.

Why the other options are incorrect:

A) Influencing the client so that he makes the choice recommended by the nurse:

This is inappropriate and unethical. The nurse’s role is to provide unbiased, evidence-based information and support the client in making informed decisions that align with his own values and preferences, not to direct or manipulate his choices.

B) Obtaining the client’s height and weight when obtaining the health history:

While height and weight are part of the physical assessment, they are not relevant to the core issue of discussing contraceptive use. This does not address the communication or relational aspect of the encounter.

D) Remembering that teenagers will not be truthful about their sexual history:

This is a biased assumption. While some teens may be hesitant, assuming dishonesty undermines trust. The nurse should instead focus on building rapport and ensuring confidentiality, which encourages honest disclosure.

Correct Answer A: releases the oestrogen directly into the uterus

Explanation:

The Levonorgestrel-releasing intrauterine system (LNG-IUS) is a progestin-only contraceptive. It does not contain or release estrogen. Instead, it releases levonorgestrel, a synthetic form of the hormone progesterone, directly into the uterus. This local hormone release thickens cervical mucus, inhibits sperm motility and function, suppresses the endometrium, and may inhibit ovulation in some users.

Why the other options are incorrect:

B) prevents pregnancy primarily by maintaining impenetrable cervical mucus and has a local effect on endometrium:

Correct. This is one of the key mechanisms of LNG-IUS action.

C) results 70% to 90% reduction of menstrual blood loss:

Correct. LNG-IUS is used therapeutically to manage heavy menstrual bleeding and significantly reduces blood loss.

D) appropriate for nulliparous women:

Correct. Although initially recommended mainly for women who have had children, newer guidelines support LNG-IUS use in nulliparous women due to its safety and effectiveness.

E) approved:

Correct. LNG-IUS is approved by regulatory agencies like the FDA and widely used for both contraception and management of heavy menstrual bleeding

Correct Answer D: fetal congenital malformations

Explanation:

Chemical and barrier contraception methods (like spermicides, diaphragms, condoms) do not cause fetal congenital malformations because they do not involve systemic medications or hormones that affect fetal development. They act locally to prevent sperm from fertilizing the egg.

Why the other options are side effects or risks:

A) Toxic shock syndrome:

Associated primarily with diaphragm or cervical cap use if left in place too long.

B) Urogenital infection:

Barrier methods can sometimes increase risk of urinary tract or vaginal infections due to irritation or disruption of normal flora.

C) Pregnancy rate between 5-15%:

Barrier and chemical methods have typical-use failure rates in this range.

E) Salpingitis:

Pelvic inflammatory disease, including salpingitis, can be associated with increased infection risk when barrier methods are not used properly or in the presence of other infections.