Chapter 08: Contraception and Abortion
MULTIPLE CHOICE
1. A woman has chosen the calendar method of conception control. Which is the most
important action the nurse should perform during the assessment process in preparation to
discuss the implementation of this method?
a. Obtain a history of the woman’s menstrual cycle lengths for the past 6 to 12
months.
b. Determine the client’s weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the client’s previous experiences with conception control.
ANS: A
The calendar method of conception control is based on the number of days in each cycle,
counting from the first day of menses. The fertile period is determined after the lengths of
menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be
partly related to hormonal fluctuations, but it has no bearing on the use of the calendar
method. Integumentary changes may be related to hormonal changes, but they are not
indicators for use of the calendar method. Exploring previous experiences with conception
control may demonstrate client understanding and compliancy, but these experiences are not
the most important aspect to assess for the discussion of the calendar method.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: AN esR
s sU SeInN
sm t GTB.COM
MSC: Client Needs: Health Promotion and Maintenance
2. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks
the nurse about the pill as a contraceptive choice. What is the nurse’s best response?
a. “Oral contraceptives are a highly effective method, but they have some side
effects.”
b. “Your current medications will reduce the effectiveness of the pill.”
c. “Oral contraceptives will reduce the effectiveness of your seizure medication.”
d. “The pill is a good choice for a woman of your age and with your personal
history.”
ANS: B
Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they
are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth
control method with side effects is a true statement, but this response is not the most
appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way
around. Stating that the pill is a good choice for a woman of her age and personal history
does not teach the client that the effectiveness of the pill may be reduced because of her
anticonvulsant therapy.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
,3. Which client would be an ideal candidate for injectable progestins such as
medroxyprogesterone acetate as a contraceptive choice?
a. The ideal candidate wants menstrual regularity and predictability.
b. The client has a history of thrombotic problems or breast cancer.
c. The ideal candidate has difficulty remembering to take oral contraceptives daily.
d. The client is homeless or mobile and rarely receives health care.
ANS: C
Advantages of medroxyprogesterone acetate includes its contraceptive effectiveness,
compared with the effectiveness of combined oral contraceptives, and the requirement of
only four injections a year. The disadvantages of injectable progestins are prolonged
amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of
venous thrombosis and thromboembolism. To be effective, injections must be administered
every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential
complications.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
4. A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to
explain the major differences between the cervical cap and the diaphragm. What is the most
appropriate response by the nurse?
a. “No spermicide is used with the cervical cap, so it’s less messy.”
b. “The diaphragm can be left in place longer after intercourse.”
c. “Repeated intercourse w NiUthRthSeIdNiaGphTraBg.mCisOmMore convenient.”
d. “The cervical cap can be safely used for repeated acts of intercourse without
adding more spermicide later.”
ANS: D
The cervical cap can be inserted hours before sexual intercourse without the need for
additional spermicide later. Spermicide should be used inside the cap as an additional
chemical barrier. The cervical cap should remain in place for 6 hours after the last act of
intercourse. Repeated intercourse with the cervical cap is more convenient because no
additional spermicide is needed.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
5. Which statement regarding emergency contraception is correct?
a. Emergency contraception requires that the first dose be taken within 120 hours of
unprotected intercourse.
b. Emergency contraception may be taken right after ovulation.
c. Emergency contraception has an effectiveness rate in preventing pregnancy of
approximately 50%.
d. Emergency contraception is commonly associated with the side effect of
menorrhagia.
, ANS: A
Emergency contraception should be taken as soon as possible or within 72 hours of
unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular
development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as
much as 75%. The most common side effect of postcoital contraception is nausea.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
6. Which is the most common technique used for the termination of a pregnancy in the second
trimester?
a. Dilation and evacuation (D&E)
b. Methotrexate administration
c. Prostaglandin administration
d. Vacuum aspiration
ANS: A
D&E can be performed at any point up to 20 weeks of gestation. It is more commonly
performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that
causes early abortion by preventing fetal cell division. Prostaglandins are also used for early
abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum
aspiration is used for abortions in the first trimester.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
NURSINGTB.COM
7. A woman will be taking oral contraceptives using a 28-day pack. What advice should the
nurse provide to protect this client from an unintended pregnancy?
a. Limit sexual contact for one cycle after starting the pill.
b. Use condoms and foam instead of the pill for as long as the client takes an
antibiotic.
c. Take one pill at the same time every day.
d. Throw away the pack and use a backup method if two pills are missed during week
1 of her cycle.
ANS: C
To maintain adequate hormone levels for contraception and to enhance compliance, clients
should take oral contraceptives at the same time each day. If contraceptives are to be started
at any time other than during normal menses or within 3 weeks after birth or an abortion,
then another method of contraception should be used through the first week to prevent the
risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and
pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the
use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If
the client misses two pills during week 1, then she should take two pills a day for 2 days and
finish the package and use a backup contraceptive method for the next 7 consecutive days.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE CHOICE
1. A woman has chosen the calendar method of conception control. Which is the most
important action the nurse should perform during the assessment process in preparation to
discuss the implementation of this method?
a. Obtain a history of the woman’s menstrual cycle lengths for the past 6 to 12
months.
b. Determine the client’s weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the client’s previous experiences with conception control.
ANS: A
The calendar method of conception control is based on the number of days in each cycle,
counting from the first day of menses. The fertile period is determined after the lengths of
menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be
partly related to hormonal fluctuations, but it has no bearing on the use of the calendar
method. Integumentary changes may be related to hormonal changes, but they are not
indicators for use of the calendar method. Exploring previous experiences with conception
control may demonstrate client understanding and compliancy, but these experiences are not
the most important aspect to assess for the discussion of the calendar method.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: AN esR
s sU SeInN
sm t GTB.COM
MSC: Client Needs: Health Promotion and Maintenance
2. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks
the nurse about the pill as a contraceptive choice. What is the nurse’s best response?
a. “Oral contraceptives are a highly effective method, but they have some side
effects.”
b. “Your current medications will reduce the effectiveness of the pill.”
c. “Oral contraceptives will reduce the effectiveness of your seizure medication.”
d. “The pill is a good choice for a woman of your age and with your personal
history.”
ANS: B
Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they
are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth
control method with side effects is a true statement, but this response is not the most
appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way
around. Stating that the pill is a good choice for a woman of her age and personal history
does not teach the client that the effectiveness of the pill may be reduced because of her
anticonvulsant therapy.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
,3. Which client would be an ideal candidate for injectable progestins such as
medroxyprogesterone acetate as a contraceptive choice?
a. The ideal candidate wants menstrual regularity and predictability.
b. The client has a history of thrombotic problems or breast cancer.
c. The ideal candidate has difficulty remembering to take oral contraceptives daily.
d. The client is homeless or mobile and rarely receives health care.
ANS: C
Advantages of medroxyprogesterone acetate includes its contraceptive effectiveness,
compared with the effectiveness of combined oral contraceptives, and the requirement of
only four injections a year. The disadvantages of injectable progestins are prolonged
amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of
venous thrombosis and thromboembolism. To be effective, injections must be administered
every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential
complications.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
4. A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to
explain the major differences between the cervical cap and the diaphragm. What is the most
appropriate response by the nurse?
a. “No spermicide is used with the cervical cap, so it’s less messy.”
b. “The diaphragm can be left in place longer after intercourse.”
c. “Repeated intercourse w NiUthRthSeIdNiaGphTraBg.mCisOmMore convenient.”
d. “The cervical cap can be safely used for repeated acts of intercourse without
adding more spermicide later.”
ANS: D
The cervical cap can be inserted hours before sexual intercourse without the need for
additional spermicide later. Spermicide should be used inside the cap as an additional
chemical barrier. The cervical cap should remain in place for 6 hours after the last act of
intercourse. Repeated intercourse with the cervical cap is more convenient because no
additional spermicide is needed.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
5. Which statement regarding emergency contraception is correct?
a. Emergency contraception requires that the first dose be taken within 120 hours of
unprotected intercourse.
b. Emergency contraception may be taken right after ovulation.
c. Emergency contraception has an effectiveness rate in preventing pregnancy of
approximately 50%.
d. Emergency contraception is commonly associated with the side effect of
menorrhagia.
, ANS: A
Emergency contraception should be taken as soon as possible or within 72 hours of
unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular
development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as
much as 75%. The most common side effect of postcoital contraception is nausea.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
6. Which is the most common technique used for the termination of a pregnancy in the second
trimester?
a. Dilation and evacuation (D&E)
b. Methotrexate administration
c. Prostaglandin administration
d. Vacuum aspiration
ANS: A
D&E can be performed at any point up to 20 weeks of gestation. It is more commonly
performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that
causes early abortion by preventing fetal cell division. Prostaglandins are also used for early
abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum
aspiration is used for abortions in the first trimester.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
NURSINGTB.COM
7. A woman will be taking oral contraceptives using a 28-day pack. What advice should the
nurse provide to protect this client from an unintended pregnancy?
a. Limit sexual contact for one cycle after starting the pill.
b. Use condoms and foam instead of the pill for as long as the client takes an
antibiotic.
c. Take one pill at the same time every day.
d. Throw away the pack and use a backup method if two pills are missed during week
1 of her cycle.
ANS: C
To maintain adequate hormone levels for contraception and to enhance compliance, clients
should take oral contraceptives at the same time each day. If contraceptives are to be started
at any time other than during normal menses or within 3 weeks after birth or an abortion,
then another method of contraception should be used through the first week to prevent the
risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and
pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the
use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If
the client misses two pills during week 1, then she should take two pills a day for 2 days and
finish the package and use a backup contraceptive method for the next 7 consecutive days.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
