Contraception and Family Planning Nursing Exam

Correct Answer C: Bacterial vaginosis

Explanation:

Bacterial vaginosis (BV) is the most common cause of malodorous, milky gray vaginal discharge with a characteristic “fishy” odor, especially after intercourse. On microscopic examination, “clue cells” (vaginal epithelial cells coated with bacteria) are a hallmark finding. BV results from an imbalance in the vaginal flora, where normal lactobacilli are replaced by overgrowth of anaerobic bacteria, such as Gardnerella vaginalis.

Why the other options are incorrect:

A. Candidiasis

Incorrect. Candidiasis is characterized by thick, white, “cottage cheese-like” discharge, vulvar itching, and redness, but not a fishy odor or clue cells.

B. Trichomoniasis

Incorrect. Trichomoniasis often presents with frothy, yellow-green discharge, vaginal irritation, and a strong odor, but clue cells are not seen. Instead, motile trichomonads may be visible on wet prep.

D. Group B Streptococcus

Incorrect. Group B Strep is typically a concern in pregnancy due to its risk of neonatal infection. It does not cause a fishy odor or clue cells, and often does not present with noticeable symptoms in non-pregnant individuals.

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 D: Fibroid

Explanation:

Uterine fibroids (leiomyomas) are not an absolute contraindication to estrogen-containing contraceptives. In fact, combined oral contraceptives may help manage symptoms such as heavy menstrual bleeding often associated with fibroids.

Why the other options are incorrect:

A) Endometrial cancer:

Estrogen-containing contraceptives are contraindicated in patients with a history of endometrial cancer due to the hormone's potential to stimulate tumor growth.

B) Lupus erythematosus:

Systemic lupus erythematosus (SLE), especially with antiphospholipid antibodies, is an absolute contraindication because of the increased risk of thrombosis.

C) Ulcerative colitis:

While not always an absolute contraindication, some patients with active or severe inflammatory bowel disease may have increased risk of thromboembolic events, making estrogen use potentially unsafe depending on the case.

Correct Answer D: Late-onset menarche

Explanation:

Late-onset menarche is generally not considered a risk factor for endometrial cancer. In fact, early menarche (early onset of menstruation) increases lifetime exposure to estrogen, which is a known risk factor for endometrial cancer. The other options—obesity, high-fat diet, and hypertension—are established risk factors due to their role in hormone imbalance and metabolic disturbances that promote endometrial cancer development.

Why the other options are correct risk factors:

A. Obesity

Excess fat tissue increases estrogen production, leading to prolonged estrogen exposure that stimulates the endometrium.

B. High-fat diet

A diet high in fat can contribute to obesity and hormonal imbalances, increasing cancer risk.

C. Hypertension

Hypertension is often associated with metabolic syndrome, which is linked to higher risk of endometrial cancer.

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 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: Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle.

Explanation:

Ovulation tends to occur about 14 days before the start of the next menstrual period in a typical 28-day cycle, which means it usually happens around day 14, give or take 2 days. This knowledge is fundamental when educating clients on fertility awareness methods for contraception or conception planning.

Why the other options are incorrect:

A) The ovum survives for 96 hours after ovulation:

This is incorrect. The ovum is viable for only 12 to 24 hours after ovulation. Sperm can survive longer (up to 5 days), but not the egg itself.

B) The basal body temperature falls at least 0.2°F after ovulation:

In fact, the basal body temperature rises slightly (by about 0.4°F to 1.0°F) after ovulation due to the effect of progesterone.

D) Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus:

While some women may feel mild mittelschmerz (ovulation pain), it is not severe for most, and cervical mucus at ovulation becomes thin, clear, and stretchy—not thick or scant.

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:

A) Headaches are a common side effect

C) Do not smoke

E) Take the pill every day at the same time

Explanation:

Ethinyl Estradiol and Norgestrel is a combined oral contraceptive pill (COC) commonly prescribed to prevent pregnancy. Nurses must provide thorough education to adolescent users to ensure safe and effective use of the medication.

A) Headaches are a common side effect:

Correct. Headaches are a well-documented side effect of combined oral contraceptives due to the hormonal fluctuations they cause. Patients should monitor the severity and frequency of headaches and report any signs of migraine with aura, as this may indicate a need to switch contraceptive methods.

C) Do not smoke:

Correct. Smoking while taking combined oral contraceptives significantly increases the risk of serious cardiovascular events, such as blood clots, stroke, and heart attack. Although the risk is higher in women over 35, the warning still applies to all users and should be emphasized to adolescents.

E) Take the pill every day at the same time:

Correct. Consistent daily dosing at the same time helps maintain effective hormone levels and maximizes contraceptive effectiveness. Missing pills or inconsistent timing can reduce protection and increase the chance of pregnancy.

Why the other options are incorrect:

B) This medication can cause gynecomastia:

Incorrect. Gynecomastia (enlargement of breast tissue) is a condition that primarily affects males and is not a typical side effect of oral contraceptives in females. This option is not relevant in this context.

D) This replaces the need for condoms:

Incorrect. While oral contraceptives are effective in preventing pregnancy, they do not protect against sexually transmitted infections (STIs). Condoms are still recommended, especially for adolescents with new or multiple partners, to reduce the risk of STIs.