Contraception and Family Planning Nursing Exam

Correct Answers

A. Family history of breast cancer,

B) Number of sexual partners,

C) Vital signs,

D) Medication history

Explanation:

A comprehensive health history is essential in family planning to ensure safe, effective, and individualized care. It helps the nurse assess risk factors, identify contraindications to certain contraceptives, and guide appropriate health counseling.

A) Family history of breast cancer:

Correct. Some hormonal contraceptives, particularly those containing estrogen, may be contraindicated in clients with a personal or strong family history of breast cancer. This information helps guide safe contraceptive choices.

B) Number of sexual partners:

Correct. Understanding the number of sexual partners helps assess the client's risk for sexually transmitted infections (STIs), which is crucial when selecting or advising on contraceptive methods and the potential need for dual protection (e.g., condoms plus another method).

C) Vital signs:

Correct. Baseline vital signs, especially blood pressure, are important when prescribing hormonal contraceptives, as some methods (like combined oral contraceptives) are contraindicated in individuals with hypertension.

D) Medication history:

Correct. Some medications, including certain antibiotics, anticonvulsants, and antiretrovirals, can interfere with the effectiveness of hormonal contraceptives. Knowing the client’s medication list is vital to avoid interactions.

Why the other option is incorrect:

E) Genital exam:

Incorrect. A genital exam is not part of the health history. It is a physical exam, which may be performed later as part of a full reproductive health assessment if indicated. It is not required for initiating most forms of contraception, such as pills, patches, or injections.

Correct Answer B: Combined oral contraceptive pills

Explanation:

Combined oral contraceptive pills (COCPs) are effective in treating dysmenorrhea (painful menstruation) because they suppress ovulation, reduce endometrial thickness, and decrease prostaglandin production, which helps alleviate menstrual cramps. COCPs provide both contraceptive benefits and therapeutic relief from menstrual pain.

Why the other options are incorrect:

A) IUD:

This depends on the type of IUD. Copper IUDs may actually worsen dysmenorrhea, especially in the first few months after insertion. Hormonal IUDs (e.g., LNG-IUS) can reduce menstrual pain, but the question does not specify type, making this option too broad to be the best choice.

C) Barrier methods:

While barrier methods like condoms provide contraception, they do not affect the menstrual cycle or reduce menstrual pain. They offer no therapeutic benefit for dysmenorrhea.

D) Emergency contraception:

Emergency contraception is used after unprotected sex to prevent pregnancy and is not suitable for regular use or for managing menstrual symptoms like dysmenorrhea.

Correct Answer C: 5 years

Explanation:

Copper IUDs (such as Paragard or other regional equivalents) are more than 99% effective at preventing pregnancy and are classified as long-acting reversible contraceptives (LARCs). Depending on the specific brand and country, copper IUDs can be effective for up to 5 to 10 years. The most commonly used types are officially approved for at least 5 years, with some extended to 10 years.

Why the other options are incorrect:

A) 1 year:

Incorrect. Copper IUDs are not designed for short-term use. They are effective for several years.

B) 3 years:

Incorrect. This is more typical of certain hormonal IUDs like Kyleena, not copper-based devices.

D) 20 years:

Incorrect. While some studies suggest copper IUDs may still be effective up to 12 years or more, current clinical approval generally limits use to 5–10 years, not 20.

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: 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 A: Zygote intrafallopian transfer (ZIFT)

Explanation:

Zygote intrafallopian transfer (ZIFT) involves fertilizing the egg outside the body (like in IVF), but instead of transferring the embryo to the uterus, the zygote (fertilized ovum) is transferred to the fallopian tube approximately one day after fertilization. This procedure combines aspects of IVF and natural conception by allowing early development to occur in the fallopian tube.

Why the other options are incorrect:

B) Tubal embryo transfer (TET):

TET is similar to ZIFT but involves transferring a more developed embryo, typically at the 2- to 4-cell stage or later, into the fallopian tube. In ZIFT, transfer occurs at the zygote stage (single-cell).

C) In vitro fertilization (IVF):

IVF involves fertilizing the egg in a lab and then transferring the embryo into the uterus, not the fallopian tube. The scenario describes fallopian tube transfer, which rules out standard IVF.

D) Gamete intrafallopian transfer (GIFT):

In GIFT, unfertilized egg and sperm are placed together in the fallopian tube, allowing fertilization to occur naturally inside the body. The scenario involves fertilization happening in the lab, which is not GIFT.

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 C: Combined hormonal contraceptives

Explanation:

Combined hormonal contraceptives (CHCs), which contain estrogen, are contraindicated in women over age 35 who smoke and/or have risk factors for thromboembolism (such as a personal or strong family history of VTE or migraines with aura). Estrogen increases the risk of blood clots, stroke, and cardiovascular events in such individuals.

Why the other options are incorrect:

A) Intrauterine device (IUD):

Safe and effective. Both hormonal and non-hormonal IUDs do not contain estrogen and do not increase VTE risk.

B) Progestin-only pill:

Safe. These pills do not contain estrogen, making them suitable for women with VTE risk or migraines.

D) Condoms:

Safe. Condoms are non-hormonal and carry no systemic health risks.

Correct Answer A: This contraceptive puts you at a higher risk of pelvic inflammatory disease.

Explanation:

An intrauterine device (IUD) is a long-acting, reversible contraceptive method that is highly effective in preventing pregnancy. However, women with multiple sexual partners are at increased risk of exposure to sexually transmitted infections (STIs). When an STI ascends into the uterus or fallopian tubes, especially in the presence of an IUD, it increases the likelihood of developing pelvic inflammatory disease (PID). PID can lead to chronic pelvic pain, infertility, or ectopic pregnancy. Therefore, while the IUD is not contraindicated, the nurse must counsel the patient on the importance of STI screening and consistent condom use to reduce her risk of infection and complications.

Why the other options are incorrect:

B) The intrauterine device can interfere with sex

There is no clinical evidence that an IUD interferes with sexual intercourse. Most users and their partners cannot feel the device during sex, and it does not affect libido, comfort, or sexual function. If strings are trimmed correctly and the device is properly placed, interference during intercourse is not a concern.

C) The intrauterine device can offer you protection from sexually transmitted infections and is a good option

The IUD is effective in preventing pregnancy, but it offers no protection against sexually transmitted infections (STIs). Only barrier methods like condoms provide that protection. Advising a patient that the IUD prevents STIs is misleading and could lead to unprotected sex and increased infection risk.

D) The intrauterine device will increase the chances of pregnancy

The IUD does not increase the risk of pregnancy. On the contrary, both hormonal and non-hormonal (copper) IUDs are among the most effective contraceptive methods, with a failure rate of less than 1%. Suggesting it increases pregnancy risk contradicts well-established clinical data.