Question 1

A primary care NP prescribes a COCP for a woman who is taking them for the first time.After teaching,the woman should correctly state the need for using a backup form of contraception if she:

Accepted Answer

Vomiting and diarrhea may cause oral contraceptive failure,so women should be advised to use backup contraception if they experience these.The other conditions do not lead to oral contraceptive failure.

Question 2

The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners.Which statement by the patient indicates she understands the regimen?

Accepted Answer

The extended-cycle pills have fewer pill-free intervals,so women have only four periods a year.Patients take pills every day.Because this patient has multiple partners,she should continue to use condoms.This type of pill has the same side effects as other types.

Question 3

A sexually active patient tells the primary care NP that she has been unable to get her new COCP pill pack until today and has missed 3 days of pills.The NP should tell her to:

Accepted Answer

Patients who miss 2 or more pills at the beginning or end of a pack should use emergency contraceptive pills,such as the Plan B pill,restart a new pill pack,and use backup contraception for 7 days.

Question 4

A woman who has been taking a COCP tells the primary care NP that,because of frequent changes in her work schedule,she has difficulty remembering to take her pills.The woman and the NP decide to change to a vaginal ring.The NP will instruct her to insert the ring:

Accepted Answer

Patients should be switched from a COCP to a vaginal ring by insertion within 7 days after the last active pill.No backup method is needed.Patients do not need to continue one more cycle of COCPs.Women taking progestin-only pills insert the ring on the last day of the pill pack.

Question 5

A woman who has been taking a COCP for 2 months tells the primary care NP that she has had several headaches,breakthrough bleeding,and nausea.The NP should counsel the woman:

Accepted Answer

Breakthrough bleeding,nausea,and headaches are common during the first 3 months of therapy and should improve without intervention.Progestin-only pills are used for lactating women only.Prolonged bleeding and severe headache would warrant discontinuation of the COCP.Backup contraception is not indicated.

Question 6

A primary care NP prescribes a COCP for a woman who has never taken oral contraceptives before.The woman is in a monogamous relationship,and she and her partner have been using condoms and wish to stop using them.Her last period was 1 week ago.The NP should:

Accepted Answer

To start COCPs using the quick start method,the woman takes the first pill on the day of her office visit and uses a barrier method such as condoms for the first 7 days.The patient should be reasonably sure she is not pregnant; she can take a pregnancy test in 2 to 3 weeks if pregnancy is suspected later.If she is pregnant,taking the COCPs would not negatively affect early pregnancy.

Question 7

A woman who is taking a progestin-only pill has just stopped nursing her 9-month-old infant and tells the primary care NP that she would like to space her children about 2 years apart.The NP should:

Accepted Answer

Serum folate levels may be decreased by oral contraceptives.Women who become pregnant shortly after stopping oral contraceptive use may have a greater chance of birth defects.This woman should become pregnant in about 6 months if she wants to space her children 2 years apart,so she needs an oral contraceptive.Progestin-only pills are used only during lactation.

Question 8

An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won't have to deal with pills or periods.The primary care NP should tell her that she:

Accepted Answer

Because of strong progestational effects on the endometrium,irregular bleeding or spotting is common in the early months of use.Because of concerns about the effect of depot medroxyprogesterone acetate on bone density,it is recommended that woman change to another birth control method after 2 years,not 1 year.Calcium and vitamin D supplements have not been shown to prevent bone density loss.It is not necessary to take oral contraceptive pills when taking antibiotics.

Question 9

A woman who began taking a COCP 2 months ago calls the primary care NP to report having nausea every day.She takes a pill at the same time each morning.The NP should tell her to:

Accepted Answer

If nausea occurs when taking the pill,patients should be instructed to switch to the opposite time of day or to take with food.A urine pregnancy test is not indicated.If nausea occurs,patients should take the pill with food.Patients stop taking pills for 7 days at the end of each 21-day pack.

Question 10

A 40-year-old woman tells the primary care nurse practitioner (NP)that she does not want more children and would like a contraceptive.She does not smoke and has no personal or family history of cardiovascular disease.She has frequent tension headaches.For this patient,the NP should prescribe:

Accepted Answer

Low-estrogen COCPs are recommended for women older than 40 with or without cardiovascular risk.Monophasic COCPs are recommended for women with migraine headaches.Condoms are more useful for preventing sexually transmitted diseases and not as reliable as contraception.Tubal ligation has surgical risks.

Question 11

A woman who uses a transdermal contraceptive calls the primary care NP to report that while dressing that morning she discovered that the patch had come off and she was unable to find the patch.The NP should tell her to apply a new patch and:

Accepted Answer

If a transdermal patch has been discovered to be loose or has come off,patients should use a backup method of contraception.It is not necessary to use oral contraceptives.A home pregnancy test is not indicated.

Question 12

A postpartum woman will begin taking the minipill while she is nursing her infant.The primary care NP should instruct the patient:

Accepted Answer

Minipills are used primarily in breastfeeding women.There is no increased risk for thromboembolic events for women taking these pills.It is not necessary to use a backup method of contraception.Women should be advised to contact the provider when they stop nursing so that a COCP can be prescribed.The more disrupted the bleeding pattern,the more likely it is that ovulation is inhibited.

Quiz 54: Contraceptives