Which contraceptive method provides protection against sexually transmitted infections?
Oral contraceptives
Tubal ligation
Male or female condoms*
Intrauterine device (IUD)
Because condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted infection. Only the barrier
methods provide some protection from sexually transmitted infections. A tubal ligation is considered a permanent contraceptive method but does not offer any
protection against sexually transmitted infections. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted infections.
3.Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse tells him to:
ejaculate into a sterile container.
obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days.*
transport specimen with container packed in ice.
ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.
An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath
that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the
laboratory within 2 hours of ejaculation.
4.The nurse is teaching the nursing student about semen analysis. Which statement by the student indicates the need for further teaching?
"The patient should be instructed to masturbate to obtain the semen sample."
"A cold environment or low temperature is suitable for storing the semen sample."*
"The test must be performed within 2 hours of collecting the semen sample."
"A spermicide-free plastic sheath must be used to collect the semen sample."
Semen samples should not be kept in a cold environment or at low temperatures as it reduces the sperm motility. For collecting the semen sample, the patient
should be instructed to masturbate, as it stimulates the impulse. For accurate estimation of sperm count, the test should be performed within 2 hours after
collecting the semen sample. This helps to prevent deterioration of the sample. To keep the sperm alive, semen samples should be collected in plastic sheaths
that are free from any spermicidal agent.
5.A woman calls the clinic asking the nurse what to do for one missed combined oral contraceptive pill. Which instructions should the nurse give the woman?
Select all that apply.
No backup method is needed.*
Take the next dose at the usual time.*
Take one active pill as soon as possible.*
Take two pills then resume one tablet daily.
Use a backup contraceptive for the next seven days.
For one missed combined oral contraceptive pill the nurse instructs the woman to continue the pack as usual, take the next dose at the usual time and take one
active pill as soon as possible. Two pills should not be taken and no backup contraceptive is necessary.
6.After having a discussion with a patient, the nurse finds that the patient has regular menstrual cycles every 28 days. What instructions should the nurse give to
the patient to prevent conception?
The couple should abstain from sexual intercourse from days 10 through 17.*
The couple should abstain from sexual intercourse from days 6 through 19.
It is safe to have unprotected sexual intercourse from days 11 through 17.
It is safe to have unprotected sexual intercourse from days 12 through 16.
The patient has regular menstrual cycles of 28 days. The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest
cycle. The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. Therefore, according to the formula, the fertile
days are from day 10 through day 17 (shortest cycle, 28 - 18 = day 10, and longest cycle, 38 - 11 = day 17). Therefore, the nurse should advise the patient to
abstain from sexual intercourse between days 10 and 17. If the woman has a shortest cycle of 24 days and a longest cycle of 30 days, then the couple should
abstain from sexual intercourse from days 6 through 19. As per the calculation, women who have regular cycles of 28 days should not have unprotected sexual
intercourse between days 11 and 17 and days 12 through 16 because it is a fertile period.
8.A patient is administered progestins (Depo-Provera) through the intramuscular route. What should the nurse suggest to the patient to prevent complications?
The patient should increase:
Iron intake.
Calcium intake.*
Protein intake.
Potassium intake.
Patients who take progestins such as depot medroxyprogesterone acetate (Depo-Provera) may lose significant bone mineral density, which may cause
osteoporosis in time. Therefore, the nurse should recommend increasing the daily calcium intake for patients who are on progestins. Iron intake is encouraged
in the patients who are anemic; progestins do not cause anemia. Progestins do not affect the protein and potassium levels in the body. Therefore, the nurse need
not suggest that the patient eat a diet rich in protein or potassium.
9.A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the
first test to be performed?
Semen analysis*
Testicular biopsy
Endometrial biopsy
Hysterosalpingogram
Semen analysis is usually the first test to be performed because it is least costly and noninvasive. A testicular biopsy is an invasive examination using a local
anesthetic. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. Hysterosalpingogram uses contrast medium to
evaluate the structure and patency of the uterus and tubes.
10.While assessing a patient, the nurse finds that the patient's shortest and longest amount of time between menstrual periods is 25 and 28 days, respectively.
The nurse teaches the patient the method to calculate the fertile period. The nurse then asks the patient which day carries the maximum chances of conception.
Which response by the patient indicates effective learning?
2nd day
6th day
10th day*
, 19th day
In the calendar rhythm method, the fertile period is calculated by subtracting 18 days from the shortest amount of time between menstrual periods and
subtracting 11 from the longest amount of time between menstrual periods. The patient's fertile period would last from 25 – 18 = 7 days to 28 – 11 = 17 days.
Therefore, on the 10th day, there would be maximum chances of conceiving. Ovulation might not happen on the 2nd and the 6th day; therefore, chances of
conception are less. The ovum may not be viable till the 19th day; therefore, conception may not happen.
7.During a bimanual examination of a patient, the nurse finds abnormal contours of the uterus and uterine tube. What should the nurse infer from these
findings? The patient:
Is at risk for endometriosis.
Is at risk of uterine fibroid.
Is at risk for an early miscarriage.*
Has polycystic ovarian disease.
Uterine abnormalities increase the risk of early miscarriages. Bimanual examination of internal organs is helpful for identifying any abnormalities in the uterus
and fallopian tubes. Abnormality in the contours of the uterus and fallopian tubes indicate that the patient has a risk of an early miscarriage. Endometriosis is a
condition in which endometrial tissue appears outside the uterus. It is not caused by abnormal contours of the uterus and fallopian tubes. Uterine fibroids
develop as benign tumors in the uterus. Polycystic ovarian disease is a genetic disorder and does not occur due to abnormal contours of the uterus and fallopian
tubes.
11.What should the nurse include when educating a patient about the side effects of depot medroxyprogesterone acetate (DMPA) prior to administration? Select
all that apply.
Breast changes*
Increased libido
Weight loss
Thromboembolism*
Irregular vaginal spotting*
Depot medroxyprogesterone acetate (DMPA) is an effective contraceptive compared to other combined oral contraceptives. It has a long-lasting effect. Breast
changes, thromboembolism, and irregular vaginal spotting are side effects of DMPA. DMPA decreases libido and increases body weight. Therefore, increases
in libido and weight loss are not side effects of DMPA.
1After checking the laboratory report of a patient, the nurse reports to the primary health care provider findings that the patient has developed insulin resistance
and anovulation. What should the nurse expect to be prescribed for the patient?
Danazol (Danocrine) and glipizide (Glucotrol)
Bromocriptine (Parlodel) and glyburide (Diabeta)
Progesterone (Prometrium) and acarbose (Precose)
Clomiphene (Clomid) and metformin (Glucophage)*
The patient has anovulation and insulin resistance. Therefore, the primary health care provider may prescribe a combination of clomiphene to promote
ovulation and metformin to control blood sugar levels. Clomiphene increases pituitary production and increases the production of follicle-stimulating hormone.
Insulin resistance causes hyperinsulinemia, which is a feature of polycystic ovary syndrome. This causes anovulation and leads to infertility in the patient.
Danazol (Danocrine) is used for the treatment of endometriosis. Glipizide (Glucatrol) and glyburide (Diabeta) are oral hypoglycemic agents but do not work on
patients with insulin resistance. Bromocriptine (Parlodel) is used for patients who have excess prolactin. Progesterone (Prometrium) is used for the treatment of
endometriosis. Acarbose (Precose) works in the gastrointestinal tract on carbohydrates for diabetes mellitus.
2.Which woman is a safe candidate for the use of oral contraceptives?
39-year-old with a history of thrombophlebitis
16-year-old with a benign liver tumor
20-year-old who suspects she may be pregnant
43-year-old who does not smoke cigarettes*
Heavy cigarette smoking is a contraindication. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant,
preclude the use of oral contraceptives. Pregnancy is a contraindication.
1When using the basal body temperature method of family planning, the woman should know that:
She will remain fertile for five days after ovulation.
She should take her temperature each night before going to bed.
Her temperature will increase about 0.4° to 0.8° F after ovulation.*
Her temperature is normally lower during the second half of her cycle.
The basal body temperature will increase about 0.4° to 0.8° F when ovulation occurs The woman is fertile for up to 18 days. She should take her temperature
upon rising in the morning. A woman's temperature is usually higher in the second half of her cycle.
2.Which symptom in a woman who is using oral contraceptives should be reported to the physician immediately?
5-pound weight gain in a month
Leg pain and edema*
Decreased menstrual flow
Increased pigmentation of the face
Oral contraceptives increase clotting factors that may place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A
5-lb weight gain in the first month is a common finding. A decrease in menstrual flow is an expected finding. An increased pigmentation of the face is a
common finding.
3.A patient is being treated for a defect in the luteal phase. The nurse instructs the patient to start taking the drug on the fifth day of menstruation and continue
for the next 5 days. Which drug is prescribed for the patient?
Progesterone (Camila)
Clomiphene citrate (Clomid)*
Nafarelin acetate (Synarel)
Metformin (Glucophage)
Clomiphene citrate (Clomid) is used to treat luteal phase defects and induce ovulation. This drug is administered on the fifth day of menstruation. The
medication is continued for the next 5 days in order to induce ovulation. Progesterone (Camila) is used to increase the luteal phase of menstruation, which is
administered as a vaginal gel once per day. If ovulation is induced by Camila, the drug is continued until after 10 to 12 weeks of pregnancy. Nafarelin acetate
(Synarel) is a gonadotropin-releasing hormone (GnRH) agonist used to treat endometriosis and uterine fibroids. It is a nasal spray used for 6 months.
Metformin (Glucophage) is an oral hypoglycemia agent and has no role in treatment of luteal phase defects.
Oral contraceptives
Tubal ligation
Male or female condoms*
Intrauterine device (IUD)
Because condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted infection. Only the barrier
methods provide some protection from sexually transmitted infections. A tubal ligation is considered a permanent contraceptive method but does not offer any
protection against sexually transmitted infections. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted infections.
3.Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse tells him to:
ejaculate into a sterile container.
obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days.*
transport specimen with container packed in ice.
ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.
An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath
that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the
laboratory within 2 hours of ejaculation.
4.The nurse is teaching the nursing student about semen analysis. Which statement by the student indicates the need for further teaching?
"The patient should be instructed to masturbate to obtain the semen sample."
"A cold environment or low temperature is suitable for storing the semen sample."*
"The test must be performed within 2 hours of collecting the semen sample."
"A spermicide-free plastic sheath must be used to collect the semen sample."
Semen samples should not be kept in a cold environment or at low temperatures as it reduces the sperm motility. For collecting the semen sample, the patient
should be instructed to masturbate, as it stimulates the impulse. For accurate estimation of sperm count, the test should be performed within 2 hours after
collecting the semen sample. This helps to prevent deterioration of the sample. To keep the sperm alive, semen samples should be collected in plastic sheaths
that are free from any spermicidal agent.
5.A woman calls the clinic asking the nurse what to do for one missed combined oral contraceptive pill. Which instructions should the nurse give the woman?
Select all that apply.
No backup method is needed.*
Take the next dose at the usual time.*
Take one active pill as soon as possible.*
Take two pills then resume one tablet daily.
Use a backup contraceptive for the next seven days.
For one missed combined oral contraceptive pill the nurse instructs the woman to continue the pack as usual, take the next dose at the usual time and take one
active pill as soon as possible. Two pills should not be taken and no backup contraceptive is necessary.
6.After having a discussion with a patient, the nurse finds that the patient has regular menstrual cycles every 28 days. What instructions should the nurse give to
the patient to prevent conception?
The couple should abstain from sexual intercourse from days 10 through 17.*
The couple should abstain from sexual intercourse from days 6 through 19.
It is safe to have unprotected sexual intercourse from days 11 through 17.
It is safe to have unprotected sexual intercourse from days 12 through 16.
The patient has regular menstrual cycles of 28 days. The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest
cycle. The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. Therefore, according to the formula, the fertile
days are from day 10 through day 17 (shortest cycle, 28 - 18 = day 10, and longest cycle, 38 - 11 = day 17). Therefore, the nurse should advise the patient to
abstain from sexual intercourse between days 10 and 17. If the woman has a shortest cycle of 24 days and a longest cycle of 30 days, then the couple should
abstain from sexual intercourse from days 6 through 19. As per the calculation, women who have regular cycles of 28 days should not have unprotected sexual
intercourse between days 11 and 17 and days 12 through 16 because it is a fertile period.
8.A patient is administered progestins (Depo-Provera) through the intramuscular route. What should the nurse suggest to the patient to prevent complications?
The patient should increase:
Iron intake.
Calcium intake.*
Protein intake.
Potassium intake.
Patients who take progestins such as depot medroxyprogesterone acetate (Depo-Provera) may lose significant bone mineral density, which may cause
osteoporosis in time. Therefore, the nurse should recommend increasing the daily calcium intake for patients who are on progestins. Iron intake is encouraged
in the patients who are anemic; progestins do not cause anemia. Progestins do not affect the protein and potassium levels in the body. Therefore, the nurse need
not suggest that the patient eat a diet rich in protein or potassium.
9.A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the
first test to be performed?
Semen analysis*
Testicular biopsy
Endometrial biopsy
Hysterosalpingogram
Semen analysis is usually the first test to be performed because it is least costly and noninvasive. A testicular biopsy is an invasive examination using a local
anesthetic. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. Hysterosalpingogram uses contrast medium to
evaluate the structure and patency of the uterus and tubes.
10.While assessing a patient, the nurse finds that the patient's shortest and longest amount of time between menstrual periods is 25 and 28 days, respectively.
The nurse teaches the patient the method to calculate the fertile period. The nurse then asks the patient which day carries the maximum chances of conception.
Which response by the patient indicates effective learning?
2nd day
6th day
10th day*
, 19th day
In the calendar rhythm method, the fertile period is calculated by subtracting 18 days from the shortest amount of time between menstrual periods and
subtracting 11 from the longest amount of time between menstrual periods. The patient's fertile period would last from 25 – 18 = 7 days to 28 – 11 = 17 days.
Therefore, on the 10th day, there would be maximum chances of conceiving. Ovulation might not happen on the 2nd and the 6th day; therefore, chances of
conception are less. The ovum may not be viable till the 19th day; therefore, conception may not happen.
7.During a bimanual examination of a patient, the nurse finds abnormal contours of the uterus and uterine tube. What should the nurse infer from these
findings? The patient:
Is at risk for endometriosis.
Is at risk of uterine fibroid.
Is at risk for an early miscarriage.*
Has polycystic ovarian disease.
Uterine abnormalities increase the risk of early miscarriages. Bimanual examination of internal organs is helpful for identifying any abnormalities in the uterus
and fallopian tubes. Abnormality in the contours of the uterus and fallopian tubes indicate that the patient has a risk of an early miscarriage. Endometriosis is a
condition in which endometrial tissue appears outside the uterus. It is not caused by abnormal contours of the uterus and fallopian tubes. Uterine fibroids
develop as benign tumors in the uterus. Polycystic ovarian disease is a genetic disorder and does not occur due to abnormal contours of the uterus and fallopian
tubes.
11.What should the nurse include when educating a patient about the side effects of depot medroxyprogesterone acetate (DMPA) prior to administration? Select
all that apply.
Breast changes*
Increased libido
Weight loss
Thromboembolism*
Irregular vaginal spotting*
Depot medroxyprogesterone acetate (DMPA) is an effective contraceptive compared to other combined oral contraceptives. It has a long-lasting effect. Breast
changes, thromboembolism, and irregular vaginal spotting are side effects of DMPA. DMPA decreases libido and increases body weight. Therefore, increases
in libido and weight loss are not side effects of DMPA.
1After checking the laboratory report of a patient, the nurse reports to the primary health care provider findings that the patient has developed insulin resistance
and anovulation. What should the nurse expect to be prescribed for the patient?
Danazol (Danocrine) and glipizide (Glucotrol)
Bromocriptine (Parlodel) and glyburide (Diabeta)
Progesterone (Prometrium) and acarbose (Precose)
Clomiphene (Clomid) and metformin (Glucophage)*
The patient has anovulation and insulin resistance. Therefore, the primary health care provider may prescribe a combination of clomiphene to promote
ovulation and metformin to control blood sugar levels. Clomiphene increases pituitary production and increases the production of follicle-stimulating hormone.
Insulin resistance causes hyperinsulinemia, which is a feature of polycystic ovary syndrome. This causes anovulation and leads to infertility in the patient.
Danazol (Danocrine) is used for the treatment of endometriosis. Glipizide (Glucatrol) and glyburide (Diabeta) are oral hypoglycemic agents but do not work on
patients with insulin resistance. Bromocriptine (Parlodel) is used for patients who have excess prolactin. Progesterone (Prometrium) is used for the treatment of
endometriosis. Acarbose (Precose) works in the gastrointestinal tract on carbohydrates for diabetes mellitus.
2.Which woman is a safe candidate for the use of oral contraceptives?
39-year-old with a history of thrombophlebitis
16-year-old with a benign liver tumor
20-year-old who suspects she may be pregnant
43-year-old who does not smoke cigarettes*
Heavy cigarette smoking is a contraindication. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant,
preclude the use of oral contraceptives. Pregnancy is a contraindication.
1When using the basal body temperature method of family planning, the woman should know that:
She will remain fertile for five days after ovulation.
She should take her temperature each night before going to bed.
Her temperature will increase about 0.4° to 0.8° F after ovulation.*
Her temperature is normally lower during the second half of her cycle.
The basal body temperature will increase about 0.4° to 0.8° F when ovulation occurs The woman is fertile for up to 18 days. She should take her temperature
upon rising in the morning. A woman's temperature is usually higher in the second half of her cycle.
2.Which symptom in a woman who is using oral contraceptives should be reported to the physician immediately?
5-pound weight gain in a month
Leg pain and edema*
Decreased menstrual flow
Increased pigmentation of the face
Oral contraceptives increase clotting factors that may place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A
5-lb weight gain in the first month is a common finding. A decrease in menstrual flow is an expected finding. An increased pigmentation of the face is a
common finding.
3.A patient is being treated for a defect in the luteal phase. The nurse instructs the patient to start taking the drug on the fifth day of menstruation and continue
for the next 5 days. Which drug is prescribed for the patient?
Progesterone (Camila)
Clomiphene citrate (Clomid)*
Nafarelin acetate (Synarel)
Metformin (Glucophage)
Clomiphene citrate (Clomid) is used to treat luteal phase defects and induce ovulation. This drug is administered on the fifth day of menstruation. The
medication is continued for the next 5 days in order to induce ovulation. Progesterone (Camila) is used to increase the luteal phase of menstruation, which is
administered as a vaginal gel once per day. If ovulation is induced by Camila, the drug is continued until after 10 to 12 weeks of pregnancy. Nafarelin acetate
(Synarel) is a gonadotropin-releasing hormone (GnRH) agonist used to treat endometriosis and uterine fibroids. It is a nasal spray used for 6 months.
Metformin (Glucophage) is an oral hypoglycemia agent and has no role in treatment of luteal phase defects.
