1. 1.

Plan B is a series of contraceptive pills similar in composition to birth control pills that have
been used for the past 30 years. Plan B is the brand name for levonorgestrel 0.75 mg. Pills are
most effective if taken immediately after unprotected intercourse and then again 12 hours later.
Males can purchase this contraceptive as long as they are over 18 years of age. Common side
effects include nausea, breast tenderness, vertigo, and stomach pain. CN: Physiological
adaptation; CL: Evaluate

2. 3. Birth control plans are influenced primarily by whether the mother is breast- or bottle-feeding
her infant. The maternal milk supply must be well established prior to the initiation of most
hormonal birth control methods. Low dose oral contraceptives would be the exception. Use of
estrogen/progesterone based pills and progesterone only pills are commonly initiated from 4 to 6
weeks postpartum because the milk supply is well established by this time. Prior experiences with
birth control methods have an impact on the method chosen as does the preferences of the
client’s partner; however, they are not the most infl uential factors. A history of blood clots or
thrombophlebitis is the second most important factor as several methods will be eliminated
because of their potential to place the client at risk for clotting disorders. CN: Pharmacological and
parenteral therapies; CL: Analysis

3. 4. The nurse determines that the client has understood the instructions when the client says that
she will notify her physician if she notices discharge or bleeding because this may be symptomatic
of underlying disease. Ideally, breast self-examination should be performed about 1 week after the
onset of menses because hormonal infl uences on breast tissue are at a low ebb at this time. The
client should perform breast self-examination on the same day each month only if she has
stopped menstruating (as with menopause). The client’s breasts should mirror each other. If one
breast is signifi cantly larger than the other, or if there is “pitting” of breast tissue, a tumor may be
present. CN: Reduction of risk potential; CL: Evaluate

4. 3. For a client with a menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or
minus 2 days, before the onset of the next menstrual cycle. Stated another way, the menstrual
period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occur during
the menses component of the cycle when the uterine lining is being shed. In most women, the
ovum survives for about 12 to 24 hours after ovulation, during which time conception is possible.
The basal body temperature rises 0.5° to 1.0° F when ovulation occurs. Although some women
experience some pelvic discomfort during ovulation (mittelschmerz), severe or unusual pain is
rare. After ovulation, the cervical mucus is thin and copious. CN: Health promotion and
maintenance; CL: Create

5. 1. The nurse should instruct the client to take a mild analgesic, such as ibuprofen, if menstrual
pain or “cramps” are present. The client should also eat foods rich in iron and should continue
moderate exercise during menstruation, which increases abdominal tone. Avoiding cold foods will
not decrease dysmenorrhea. Sexual intercourse is not prohibited during menstruation, but the
male partner should wear a condom to prevent exposure to blood. CN: Health promotion and
maintenance; CL: Apply

6. 1. Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. This is an important
point to make with adolescents who may be sexually active. Many people believe that the time
 interval is much longer and that they can wait until after intercourse to take steps to prevent
conception. Without protection, pregnancy and sexually transmitted diseases can occur. When
using the abstinence or calendar method, the couple should abstain from intercourse on the days
of the menstrual cycle when the woman is most likely to conceive. Using a 28-day Billings_Part
2_Chap 1_Test 1.indd 44 illings_Part 2_Chap 1_Test 1.indd 44 8/7/2010 12:48:30 PM /7/2010
12:48:30 PM Antepartal Care 45 cycle as an example, a couple should abstain from coitus 3 to 4
days before ovulation (days 10 through 14) and 3 to 4 days after ovulation (days 15 through 18).
Sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. If
the female client ovulates after coitus, there is a possibility that fertilization can occur. Before
fertilization, the ovum and sperm each contain 23 chromosomes. After fertilization, the conceptus
contains 46 chromosomes unless there is a chromosomal abnormality. CN: Health promotion and
maintenance; CL: Evaluate

7. 3. The symptothermal method is a natural method of fertility management that depends on

knowing when ovulation has occurred. Because regular menstrual cycles can vary by 1 to 2 days
in either direction, the symptothermal method requires daily basal body temperature assessments
plus close monitoring of cervical mucus changes. The method relies on abstinence during the
period of ovulation, which occurs approximately 14 days before the beginning of the next cycle.
Abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation
will occur during this time period (days 1 through 10). Typically, the failure rate for this method is
between 10% and 20%. Although a condom may increase the effectiveness of this method, most
clients who choose natural methods are not interested in chemical or barrier types of family
planning. CN: Health promotion and maintenance; CL: Create

8. 2. Before advising a client about oral contraceptives, the nurse needs to assess the client for
signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or
a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives.
In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary
disease should be advised to use a different method. Iron-defi ciency anemia, dysmenorrhea, and
acne are not contraindications for the use of oral contraceptives. Irondefi ciency anemia is a
common disorder in young women. Oral contraceptives decrease the amount of menstrual fl ow
and thus decrease the amount of iron lost through menses, thereby providing a benefi cial effect
when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be
effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is
thought to be caused by the release of prostaglandins in response to tissue destruction during the
ischemic phase of the menstrual cycle. Use of oral contraceptives commonly improves facial
acne. CN: Reduction of risk potential; CL: Analyze

9. 4. The nurse determines that the client needs further instruction when the client says that one of
the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian
and endometrial cancer are reduced in women using oral contraceptives. Other adverse effects of
oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial
infections. The most serious adverse effect is thrombophlebitis. CN: Pharmacological and
parenteral therapies; CL: Evaluate
10. 1. The typical failure rate of a condom is approximately 12% to 14%. Adding a spermicide can
decrease this potential failure rate because it offers additional protection against pregnancy.
Natural skin condoms do not offer the same protection against sexually transmitted diseases
caused by viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms
do not prevent the passage of viruses. Most condom users report decreased penile gland
sensitivity. However, some users do report an increased sensitivity or allergic reaction (such as a
rash) to latex, necessitating the use of another method of family planning or a switch to a natural
skin condom. CN: Health promotion and maintenance; CL: Apply
11. 2. The teaching plan should include a caution that a diaphragm should not be used if the client
develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some
studies have also associated diaphragm use with increased incidence of urinary tract infections.
Douching after use of a diaphragm and intercourse is not recommended because pregnancy
could occur. The diaphragm should be inspected and washed with mild soap and water after each
use. A diaphragm should be left in place for at least 6 hours but no longer than 24 hours after
intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this
period. CN: Reduction of risk potential; CL: Create

12. 4. The client would need additional instructions when she says that she can still use the same
diaphragm if she gains or loses 20 lb. Gaining or losing more than 15 lb can change the pelvic and
vaginal contours to such a degree that the diaphragm will no longer protect the client against
pregnancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its
case. The client should be refi tted for another diaphragm after pregnancy and delivery of a
newborn because weight changes and physiologic changes of