Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 4 Family Planning

1. A client asks the nurse, "Can you explain to us how to use the basal body temperature method to detect ovulation and prevent pregnancy?" What is the nurse's best response?
2. "Take your temperature every evening at the same time and keep a record for a period of several weeks. A noticeable drop in temperature indicates that ovulation has occurred."
3. "Take your temperature every day at the same time and keep a record of the findings. A noticeable rise in temperature indicates ovulation."
4. "Take your temperature each day, immediately upon awakening, and keep a record of each finding. A noticeable rise in temperature indicates that ovulation is about to occur."
5. "This is an unscientific and unproven method of determining ovulation, and is not recognized as a means of birth control."

Page Ref: 55

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Discuss types of fertility awareness-based methods (F A B) such as natural family planning (N F P).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse in the clinic instructs a client who is using the natural method of contraception to begin counting the first day of her cycle as which day?
2. The day her menstrual period ceases
3. The first day after her menstrual period ceases
4. The first day of her menstrual period
5. The day of ovulation

Page Ref: 55

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Discuss types of fertility awareness-based methods (F A B) such as natural family planning (N F P).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client in the women's clinic asks the nurse, "How is the cervical mucus method of contraception different from the rhythm method?" The appropriate response by the nurse is that the cervical mucus method is which of the following?
2. More effective for women with irregular cycles
3. Not acceptable to women of many different religions
4. Harder to work with than the rhythm method
5. Requires an artificial substance or device

Page Ref: 54

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Discuss types of fertility awareness-based methods (F A B) such as natural family planning (N F P).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client who wants to use the vaginal sponge method of contraception shows that she understands the appropriate usage when she makes which statement?
2. "I need to use a lubricant prior to insertion."
3. "I need to add spermicidal cream prior to intercourse."
4. "I need to moisten it with water prior to use."
5. "I need to leave it in no longer than 6 hours."

Page Ref: 56

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Compare the barrier methods of contraception with regard to correct use and advantages and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A female client who is 36 years old, weighs 200 pounds, is monogamous, and does not smoke desires birth control. The nurse understands that which contraceptive method is inappropriate for this client?
2. Intrauterine device
3. Vaginal sponge
4. Combined oral contraceptives
5. Transdermal hormonal contraception

Page Ref: 64—65

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families and the healthcare team. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 6 Compare progestin-only hormonal contraceptive methods to combined hormonal estrogen-progestin methods of the following: Medroxyprogesterone acetate injection (Depo-Provera), the norethindrone "mini-pill" (Micronor), and etonogestrel subdermal implant (Nexplanon).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. When assessing a client asking about birth control, the nurse knows that the client would not be a good candidate for Depo-Provera (D M P A) if which of the following is true?
2. She wishes to get pregnant within 3 months.
3. She is a nursing mother.
4. She has a vaginal prolapse.
5. She weighs 200 pounds.

Page Ref: 65

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Compare progestin-only hormonal contraceptive methods to combined hormonal estrogen-progestin methods of the following: Medroxyprogesterone acetate injection (Depo-Provera), the norethindrone "mini-pill" (Micronor), and etonogestrel subdermal implant (Nexplanon).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A couple asks the nurse what is the safest method of sterilization. What should the nurse reply?
2. "Laparotomy tubal ligation."
3. "Laparoscopy tubal ligation."
4. "Minilaparotomy."
5. "Vasectomy."

Page Ref: 66

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 10 Contrast the forms of sterilization (tubal ligation and vasectomy) with regard to risk, effectiveness, advantages, and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. When the nurse is teaching a woman about the use of a diaphragm, it is important to instruct her that the diaphragm should be rechecked for correct size how often?
2. Every five years routinely
3. When weight gain or loss beyond five pounds has occurred
4. After each birth
5. Only after significant weight loss

Page Ref: 58

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Compare the barrier methods of contraception with regard to correct use and advantages and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. What issues should the nurse consider when counseling a client on contraceptive methods?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Cultural perspectives on menstruation and pregnancy
2. Effectiveness of the method
3. Future childbearing plans
4. Whether the client is a vegetarian
5. Age at menarche

Page Ref: 53

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Patient-centered Care: Skills: Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | A A C N Essentials Competencies: Clinical Prevention and Population Health: Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Describe the reasons why women and couples choose to use contraception.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. Extended use of combined oral contraceptives (C O Cs) reduces the side effects of C O Cs such as which of the following?
2. Cramping
3. Hypertension
4. Breast tenderness
5. Bloating

Page Ref: 63

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan and in all healthcare settings. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Summarize the key points that women who use combined hormonal contraceptives (estrogen and a progestin) should know, including the correct procedure for use, common side effects, warning signs, and noncontraceptive benefits of the following: Combined oral contraceptive pills, contraceptive patch (Xulane), and contraceptive vaginal ring (NuvaRing).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is discussing the use of contraception with a client who has just become sexually active. What factors should the nurse include when educating the client on contraceptive methods?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Contraindications in the client's health history
2. Religious or moral beliefs
3. Partner's belief in the effectiveness of the choice
4. Personal preferences to use method
5. Future childbearing plans

Page Ref: 53

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active relationships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Describe the reasons why women and couples choose to use contraception.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is preparing educational materials at a family planning clinic. The client who is an appropriate candidate for using emergency contraception would be one who reports which of the following?
2. Forgetting to start her pill pack yesterday
3. Unprotected intercourse during her menses
4. That a condom broke yesterday in the middle of her cycle
5. Increased dysmenorrhea since I U C insertion

Page Ref: 56

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Identify the appropriate time frame for initiating postcoital emergency contraception (E C).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is developing a teaching plan for a client undergoing a tubal ligation. What information should be included in the plan?
2. The surgical procedure is easily reversible.
3. Laparotomy is performed following a vaginal birth.
4. Minilaparotomy is performed in the postpartum period soon after a vaginal birth.
5. Tubal ligation can be done at any time the woman is either pregnant or not pregnant.

Page Ref: 66

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Skills: Engage patients and designated surrogates in active relationships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 10 Contrast the forms of sterilization (tubal ligation and vasectomy) with regard to risk, effectiveness, advantages, and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client who was raped is extremely upset when a pregnancy test confirms that she is pregnant, and requests information regarding pregnancy termination. Which statement is best for the nurse to make?
2. "Abortion is morally wrong, and should not be undertaken."
3. "Hypertension is a risk with any abortion."
4. "Surgical abortion in the first trimester is technically easier and safer than abortion in the second trimester."
5. "The most accurate method to determine gestational age are the results of a pregnancy test."

Page Ref: 68

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. C. 11. Respect patient preferences for degree of active engagement in care process. | A A C N Essentials Competencies: Ⅱ. 8. Promote achievement of safe and quality outcomes of care for diverse populations. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 11 Compare medical and surgical approaches to pregnancy termination.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A patient using the calendar rhythm method of birth control asks for assistance to calculate her most fertile period. She states that her shortest cycle is 22 days and her longest cycle is 40 days. Using this information, which day should the nurse identify as being the end of the patient's fertile period?

Page Ref: 54

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 2 Discuss types of fertility awareness-based methods (F A B) such as natural family planning (N F P).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A female patient comes into the community clinic with the following chart and asks the nurse for help understanding what needs to be done. Which method of birth control should the nurse review with the patient?

1. Two-day method
2. Basal body temperature
3. Calendar rhythm method
4. Billings ovulation method

Page Ref: 55

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Teaching/Learning.

Learning Outcome: 2 Discuss types of fertility awareness-based methods (F A B) such as natural family planning (N F P).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is coordinating educational materials in the patient training room. For which method of birth control should the nurse place the following diagram?

1. Diaphragm
2. Cervical cap
3. Male condom
4. Female condom

Page Ref: 57

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. | Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Teaching/Learning.

Learning Outcome: 4 Compare the barrier methods of contraception with regard to correct use and advantages and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is reviewing the insertion of a diaphragm with a female patient. At which step in the process is the following diagram to be used?

1. Before storing
2. After removing
3. Prior to inserting
4. Determine leaking

Page Ref: 59

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 4 Compare the barrier methods of contraception with regard to correct use and advantages and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is preparing to meet with a female patient to review the most appropriate contraceptive method. In which order should the nurse complete the steps of this process?
2. Emphasize actions if pregnancy occurs
3. Instruct on the use of the selected method
4. Review side effects and warning symptoms
5. Assess for medical contraindications to specific methods
6. Learn about lifestyle, attitudes, religious beliefs and plans for children

Page Ref: 53

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 4 Compare the barrier methods of contraception with regard to correct use and advantages and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. After reviewing approaches for contraception with a female client, the nurse is concerned that barrier methods will not achieve the client's goal to prevent pregnancy. What did the client say to cause the nurse to draw this conclusion?
2. "My partner doesn't mind wearing condoms."
3. "I don't want to have to put anything in myself."
4. "We should use a condom even with a diaphragm."
5. "I know that spermicides are inserted before intercourse."

Page Ref: 56

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation: Teaching/Learning.

Learning Outcome: 1 Describe the reasons why women and couples choose to use contraception.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is reviewing the spermicidal agent nonoxynol-9 (N-9) with a client planning to use the barrier method to prevent pregnancy. What should the nurse emphasize when teaching about this preparation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. It does not cause toxicity.
2. It is inserted after intercourse.
3. It has no systemic side effects.
4. It can be purchased over-the-counter.
5. It reduces the risk of sexually transmitted infections.

Page Ref: 56

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. | Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Identify the only spermicide preparation currently available in the United States.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client is planning to use condoms with a spermicidal cream as contraception. What should the nurse include when reviewing this method with the client?
2. Coat the condom with spermicide before using
3. Insert the spermicide 1 hour before having intercourse
4. Insert the cream high into the vagina and remain supine
5. Wait 15 minutes after inserting the spermicide into the vagina

Page Ref: 56—57

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. | Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Identify the only spermicide preparation currently available in the United States.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A sexually active female asks why an H I V test is needed since she uses condoms with spermicidal agents when having intercourse. How should the nurse respond to this client?
2. "Condoms do not protect against contracting H I V."
3. "Spermicides only control bacteria and not viruses."
4. "All sexually active people are at risk for contracting H I V."
5. "The spermicide can make your vaginal cells more susceptible to H I V."

Page Ref: 56

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Identify the only spermicide preparation currently available in the United States.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse suspects that a client is experiencing adverse effects from the progestin within a combined oral contraceptive. What did the nurse assess to make this clinical determination?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Pruritus
2. Headache
3. Hirsutism
4. Weight gain
5. Hypertension

Page Ref: 64

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. | Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation.

Learning Outcome: 5 Summarize the key points that women who use combined hormonal contraceptives (estrogen and a progestin) should know, including the correct procedure for use, common side effects, warning signs, and noncontraceptive benefits of the following: Combined oral contraceptive pills, contraceptive patch (Xulane), and contraceptive vaginal ring (NuvaRing).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. During a follow-up wellness visit, the nurse determines that a female client is experiencing favorable outcomes after starting combined oral contraceptives. What data did the nurse use to determine this?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Reduced appetite
2. Reduced menstrual flow
3. Fewer menstrual cramps
4. No pain with ovulation
5. Cycle is regular at 28 days

Page Ref: 63

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation.

Learning Outcome: 5 Summarize the key points that women who use combined hormonal contraceptives (estrogen and a progestin) should know, including the correct procedure for use, common side effects, warning signs, and noncontraceptive benefits of the following: Combined oral contraceptive pills, contraceptive patch (Xulane), and contraceptive vaginal ring (NuvaRing).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client who has been using transdermal hormonal contraception comes in for a routine wellness visit. Which finding should cause the nurse to question if the client should continue to use this form of contraception?
2. Body weight of 179 lb
3. Skin breakdown at the site of the patch
4. Drinks 2 cups of caffeinated coffee a day
5. Bicycles at the gym three evenings a week

Page Ref: 64

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation.

Learning Outcome: 6 Compare progestin-only hormonal contraceptive methods to combined hormonal estrogen-progestin methods of the following: Medroxyprogesterone acetate injection (Depo-Provera), the norethindrone "mini-pill" (Micronor), and etonogestrel subdermal implant (Nexplanon).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A female client comes into the clinic for a pregnancy test because she took the morning after pill immediately after having unprotected intercourse 3 days ago and has not had a menstrual period. What should the nurse respond to this client?
2. "I'll make sure you have one during this visit."
3. "You should wait for two weeks before having a pregnancy test."
4. "It's unlikely that you are pregnant. Wait a few days and then take a pregnancy test."
5. "How long did you wait to take the morning after pill after having unprotected intercourse?"

Page Ref: 66

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, client-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation.

Learning Outcome: 9 Identify the appropriate time frame for initiating postcoital emergency contraception (E C).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A female college student comes into the student health clinic, concerned about being pregnant from unprotected intercourse the evening before. What should the school nurse counsel this student?
2. "Take Plan B One Step now."
3. "Take 1 pill of Plan B now and the second pill in 5 days."
4. "Take one half of Plan B One Step now and the second half in 3 days."
5. "Wait 5 days and take 1 pill of Plan B followed by the second pill in 2 days."

Page Ref: 66

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 9 Identify the appropriate time frame for initiating postcoital emergency contraception (E C).

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A female client with an intrauterine device calls the clinic because she is unable to locate the strings after her last menstrual period. What should the nurse counsel this client?
2. Schedule an appointment immediately
3. Wait a few days and recheck for the strings
4. Take a tub bath and then recheck for the strings
5. Perform a douche and then recheck for the strings

Page Ref: 61

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Delineate the advantages and disadvantages of intrauterine contraception (I U C) as a method of birth control, as well as the differences between the I U Cs with hormones and the one with copper.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A female client is disappointed to learn that intrauterine contraception is not an option. For what reason is this form of contraception contraindicated for this client?
2. Diabetes
3. Breast cancer
4. Endometriosis
5. Uterine surgery

Page Ref: 63

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, client-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment.

Learning Outcome: 7 Delineate the advantages and disadvantages of intrauterine contraception (I U C) as a method of birth control, as well as the differences between the I U Cs with hormones and the one with copper.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is teaching a client who is having the Skyla L N g-I U C device inserted for contraception. What should the nurse emphasize to the client about this device?
2. This device will provide protection for 5 years
3. This device will provide protection for 10 years
4. This device should not be used with a copper allergy
5. This device has a silver ring and could interfere with an M R I

Page Ref: 61

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Delineate the advantages and disadvantages of intrauterine contraception (I U C) as a method of birth control, as well as the differences between the I U Cs with hormones and the one with copper.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client scheduled to have a Mirena levonorgestrel intrauterine system (L N g-I U C) inserted asks how this device stops conception. What should the nurse say in response to this client?
2. "It stops ovulation."
3. "It slows sperm motility."
4. "It shortens the menstrual cycle."
5. "It causes the lining of the uterus to waste away."

Page Ref: 61

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Delineate the advantages and disadvantages of intrauterine contraception (I U C) as a method of birth control, as well as the differences between the I U Cs with hormones and the one with copper.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. The nurse is completing the health history for a client desiring the Essure method of permanent sterilization. What should the nurse specifically ask when assessing this client?
2. "Are you allergic to any metals?"
3. "How many children do you have?"
4. "When was your last menstrual period?"
5. "Is your spouse aware of the procedure?"

Page Ref: 66

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment.

Learning Outcome: 10 Contrast the forms of sterilization (tubal ligation and vasectomy) with regard to risk, effectiveness, advantages, and disadvantages.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client is being prepared to take the oral mifepristone-vaginal misoprostol treatment for an abortion. For which reasons should the nurse instruct the client to contact the healthcare provider within 24 hours?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Nausea
2. Itchy skin
3. Weakness
4. Stomach pain
5. Bloody discharge

Page Ref: 69

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 11 Compare medical and surgical approaches to pregnancy termination.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.

1. A client at 10 weeks' gestation is scheduled for a surgical abortion. Which approaches may be used to dilate the cervix for the procedure?

Note: Credit will be given only if all correct choices and no incorrect choices are elected.

Select all that apply.

1. Misoprostol
2. Mifepristone
3. Metal dilators
4. Sterile seaweed
5. Paracervical block

Page Ref: 68

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of client-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, client-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning.

Learning Outcome: 11 Compare medical and surgical approaches to pregnancy termination.

M N L L O: Demonstrate understanding of family planning in the care of patients and families.