The Preconception Client

A patient has received Plan B (levonorgestrel 0.75 mg, two doses as emergency contraception. After unprotected intercourse, the patient calls the clinic to ask questions about using the contraceptives. The nurse realizes the patient needs a further explanation when she makes which of the following responses?

A. “I can wait three to four days after intercourse to start taking these to prevent pregnancy.”

B. “My boyfriend can purchase Plan B from the pharmacy if he is over 18 years old.”

C. “The birth control works by stopping ovulation or fertilization of the egg.”

D. “I may feel nauseated and have breast tenderness or a headache after using the contraceptive.”

Rationale:

Plan B is a range of contraceptive pills similar in composition to birth control pills used for the past 30 years. Plan B is the brand name for levonorgestrel 0.75 mg. Medications are most effective if taken quickly after unprotected intercourse and then again 12 hours later. Males can buy this protection as long as they are over 18 years of age. Common side effects comprise nausea, breast tenderness, vertigo, and stomach pain.

CN: Physiological adaptation; CL: Evaluate

The antenatal G 2, T 1, P 0, Ab 0, L 1 patient discusses her postpartum plans for birth control with her physician. In analyzing the available options, which of the following factors has the most significant impact on her birth control options?

A. Satisfaction with prior methods.
B. Preference of sexual partner.
C. Breastfeeding plan.
D. History of clotting disease.

Rationale C.

Birth control plans are determined primarily by whether the mother is breast- or bottle-feeding her infant. The maternal milk supply must be well established before the initiation of most hormonal birth control methods. Low-dose oral contraceptives would be the exception. The use of estrogen and 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 plans impact the method chosen, as do the preferences of the patient partner; however, they are not the most influential factors. A history of blood clots or thrombophlebitis is the second most crucial factor. Several methods will be eliminated because of their potential to place the patient at risk for clotting disorders.

CN: Pharmacological and parenteral therapies; CL: Analysis

After the nurse instructs a 20-year-old nulligravid client on how to perform a breast self-examination, which of the following client statements indicates that the teaching has been successful?

A.“I should perform breast self-examination on the day my menstrual flow begins.”
B. “I must perform breast self-examination on the same day each month.”
C. “If I notice that one of my breasts is much smaller than the other, I shouldn’t worry.”
D. “If there is discharge from my nipples, I should call my health care provider.”

Rationale D.The nurse determines that the client understands the instructions when she says that she will notify her physician if she notices discharge or bleeding because this may be symptomatic of an underlying disease. Ideally, breast self-examination should be performed about 1 week after the onset of menses because hormonal influences on breast tissue are at a low ebb at this time. The client should perform breast self-examination on the same day each month if she has stopped menstruating (as with menopause). The client’s breasts should mirror each other. A tumor may be present if one breast is significantly larger than the other or if there is “pitting” of breast tissue.

CN: Reduction of risk potential; CL: Evaluate

Assessment of a 16-year-old nulligravid client who visits the clinic and asks for information on contraceptives reveals a menstrual cycle of 28 days. The nurse formulates a nursing diagnosis of Deficient Knowledge related to ovulation and fertility management. Which of the following would be essential to include in the teaching plan for the client?

A. The ovum survives for 96 hours after ovulation, making conception possible during this time.
B. The basal body temperature falls at least 0.2° F after ovulation has occurred.
C. Ovulation usually occurs on day 14, plus or minus two days, before the onset of the next menstrual cycle.
D. Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus.

Rationale C. For a client with a menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or minus two days, before the onset of the next menstrual cycle. Stated another way, the menstrual period begins about two 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 about 12 to 24 hours after ovulation, during which conception is possible. The basal body temperature rises 0.5° to 1.0° F when ovulation occurs. Although some women experience 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

Which of the following directions about activities during menstruation would the nurse cover when counseling an adolescent who has just begun menstruating?

A. Use a mild analgesic if needed for menstrual pain.
B. Avoid cold foods if menstrual pain persists.
C. Stop exercise while menstruating.
D. Avoid sexual intercourse while menstruating.

Rationale A. The nurse should tell the client to take a mild analgesic, such as ibuprofen if menstrual pain or “cramps” are present. The client should also eat iron-rich foods and continue moderate exercise during menstruation, increasing abdominal tone. Evading 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

After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse’s teaching has been effective?

A. “Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy.”
B“I won’t become pregnant if I abstain from intercourse during the last 14 days of my menstrual cycle.”
C. “Sperm from a healthy male usually remain viable in the female reproductive tract for 96 hours.”
D.“After a sperm fertilizes an ovum, the ovum then contains 21 pairs of chromosomes.”

Rationale A. Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. This is a crucial 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 menstrual cycle days when the woman is most likely to conceive. Using a 28-day cycle, 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