The Preconception Client

Plan B (levonorgestrel 0.75 mg, 2 pills) was obtained as emergency contraception for a client. The client phones the clinic after unprotected intercourse to ask questions about using the contraceptives. When the nurse makes which of the following responses, she recognizes the client requires more information.

1. “I can start taking them three to four days after intercourse to avoid pregnancy.”
2. “If my love is beyond the age of 18, he can buy Plan B from the pharmacy.”
3. “Birth control works by stopping the egg from fertilizing or ovulation.”
4. “After applying the contraceptive, I may get nausea, breast pain, or a headache.”

CN: Evaluate CL:Physiological adaptation

Plan B is a line of contraceptive pills that are similar to birth control pills that have been around for 30 years. Levonorgestrel 0.75 mg is sold under the brand name Plan B. The pills work best when taken right after having unprotected intercourse and then again 12 hours later. Males above the age of 18 are eligible to acquire this contraception. Nausea, breast discomfort, vertigo, and stoma are all common adverse effects.

With her health care provider, a prenatal G 2, T 1, P 0, Ab 0, L 1 client discusses her postpartum birth control plans. Which of the following criteria has the biggest impact on her birth control options when reviewing the available options?

1. Contentment with previous techniques.
2. Sexual partner preference.
3. Breast-feeding or bottle-feeding strategy
4. There is a history of clotting illness in your family.

CL: Analysis; CN: Pharmacological and parenteral therapy

The mother’s choice of birth control is mostly impacted by whether she is breastfeeding or bottle-feeding her child. Most hormonal birth control treatments require a well-established mother milk supply before they may be used. The only exception would be low-dose oral contraceptives. Because the milk supply is fully established by this time, estrogen/progesterone-based tablets and progesterone-only pills are frequently started between 4 and 6 weeks postpartum. Prior experiences with birth control techniques, as well as the preferences of the client’s partner, have an impact on the method chosen; however, these are not the most relevant ones. The second most crucial criterion is a history of blood clots or thrombophlebitis, as numerous methods will be discarded due to their ability to put the client at risk for clotting diseases.

Which of the following client statements suggests that the nurse’s education of a 20-year-old nulligravid client on how to perform a breast self-examination was successful?

1. “On the first day of my monthly flow, I should do a breast self-examination.”
2. “It’s critical that I do my monthly breast self-examination on the same day.”
3. “I shouldn’t be concerned if one of my breasts is significantly smaller than the other.”
4. “I should contact my doctor if there is any leakage from my nipples.”

CL: Evaluate; CN: Reduction of risk possibility

When the client says she will inform her physician if she detects discharge or bleeding because this could be a sign of an underlying ailment, the nurse knows she has understood the instructions. Because hormonal influences on breast tissue are at a low ebb at this time, breast self-examination should be performed about 1 week after the onset of menses. Only if the client has ceased menstruating should she undertake breast self-examination on the same day each month (as with menopause). The client’s breasts should be the same. A tumor may be present if one breast is much larger than the other or if breast tissue is “pitting.”

A 16-year-old nulligravid client who comes to the clinic for contraceptive information has a 28-day menstrual cycle, according to the assessment. The nurse develops a nursing diagnosis of ovulation and fertility management knowledge deficit. Which of the following would be crucial to include in the client’s instructional plan?

1. The ovum lives for 96 hours following ovulation, allowing for conception throughout this period.
2. After ovulation, the basal body temperature drops by at least 0.2 degrees Fahrenheit.
3. Ovulation normally happens 14 days before the start of the next menstrual cycle, plus or minus 2 days.
4. Because of intense discomfort and thick, sparse cervical mucus, most women can tell when they’ve ovulated.

CL: Create; CN: Health Promotion and Maintenance

Ovulation normally happens on day 14, plus or minus 2 days, before the start of the following menstrual cycle for a client with a 28-day menstrual cycle. In other words, the menstrual cycle begins approximately 2 weeks following ovulation. Ovulation does not normally happen during the part of the cycle when the uterine lining is lost, called menses. The ovum persists for 12 to 24 hours following ovulation in most women, during which time conception is possible. When ovulation occurs, the basal body temperature rises by 0.5° to 1.0° F.Although some women suffer mild pelvic discomfort (mittelschmerz) during ovulation, severe or atypical pain is uncommon. The cervical mucus is thin and abundant after ovulation.

When counseling an adolescent who has recently started menstruating, which of the following guidelines about activities during menstruation would the nurse include?

1. If menstrual pain is severe, take a little analgesic.
2. If menstruation pain persists, avoid cold meals.
3. Do not exercise while you are menstruation.
4. Do not engage in sexual activity when menstruating.

CN: Health promotion and maintenance; CL: Apply

If the client has menstruation discomfort or “cramps,” the nurse should advise her to take a mild painkiller such as ibuprofen. During menstruation, the client should take iron-rich foods and maintain moderate activity to build abdominal tone. Dysmenorrhea will not be relieved by avoiding cold meals. Sexual activity is not forbidden during menstruation, but the male partner should use a condom to avoid blood contact.

Which of the following assertions demonstrates that the school nurse’s teaching about human reproduction was effective after holding a class for female adolescents?

1. “Sperm can reach the ovum in 15 to 30 minutes under optimum conditions, resulting in pregnancy.”
2. “If I don’t have any sexual activity during the last 14 days of my menstrual cycle, I won’t get pregnant.”
3. “Sperm from a healthy male normally lasts for 96 hours in the female reproductive tract.”
4. “An ovum contains 21 pairs of chromosomes once it has been fertilized by a sperm.”

CN: Health promotion and maintenance; CL: Evaluate

Sperm can reach the ovum in 15 to 30 minutes under optimum conditions. This is a crucial message to communicate with sexually active adolescents. Many people assume that the time delay is significantly longer and that they can take action to prevent pregnancy following intercourse. Pregnancy and sexually transmitted diseases can occur if you are not protected. The pair should abstain from intercourse on the days of the menstrual cycle when the woman is most likely to conceive when utilizing the abstinence or calendar technique. Using a 28-day cycle as an example, a couple should avoid coitus 3 to 4 days before ovulation (days 10 through 14) and 3 to 4 days following ovulation (days 15 through 18). (days 15 through 18). Sperm from a healthy male can survive in the female reproductive system for up to 72 hours. There is a chance that conception will occur if the female customer ovulates following coitus. The ovum and sperm each have 23 chromosomes before fertilization. Unless there is a chromosomal defect, the conceptus has 46 chromosomes after conception.

A nulligravid client in her twenties expresses an interest in learning more about the symptothermal approach of family planning. In the teaching plan, the nurse would include which of the following?

1. During the first year of use, this approach has a 50% failure rate.
2. After the menses, couples must refrain from coitus for 5 days.
3. Changes in cervical mucous are closely watched.
4. The male partner is a condom user with a high level of efficacy.

CL: Create; CN: Health Promotion and Maintenance

The symptothermal approach is a natural fertility management technique that relies on determining when ovulation has occurred. The symptothermal approach necessitates daily basal body temperature evaluations as well as continuous monitoring of cervical mucus changes because typical menstrual cycles might vary by 1 to 2 days in either direction. The approach is based on abstinence during the ovulation period, which lasts around 14 days before the start of the next cycle. Because ovulation is unlikely to occur during this time, abstaining from coitus for 5 days following menses is unnecessary (days 1 through 10). The failure rate for this procedure is typically between 10% and 20%. Although the use of a condom may improve the effectiveness of this procedure, most clients who choose natural methods are not interested in chemical or barrier family planning.