PHARM 5206 EXAM 2 WOMEN'S HEALTH WITH ALL
CORRECT & VERIFIED ANSWERS (UPDATED TO PASS)
What is the difference between typical versus perfect use when discussing contraceptive methods?
Correct answer-Typical use - how effective contraception is when used well but not taken exactly as
prescribed (i.e. taking medication late or forgetting it)
Perfect use - how effective contraception is when used perfectly and exactly as prescribed
Other than pregnancy prevention, what are additional benefits of hormonal contraceptives?
Correct answer-Cycle regulation
Decrease ovarian cysts
Improve PMS and PMDD
Treatment of endometriosis
Prevention of ovarian and endometrial cancer
What is the main therapeutic action of estrogen and progestin (working together) in combined
hormonal contraceptive products? Correct answer-Suppression of folliculogenesis and suppression
of ovulation.
A client who is taking combined oral contraceptives (COCs) calls the clinic to report breakthrough
bleeding. The client has been taking the medication less than 6 weeks. What advice would you give
the client? Correct answer-Provide reassurance and encourage them to continue taking the
medication for at least 3 months to allow their body time to adjust to the hormones.
A client asks you if there are any COCs other than the traditional 21/7 formulation. How would you
respond? Correct answer-Yes, there are pills that have 24 or 26 days of active pills with only 4 or 2
inactive days. There are also 91 day pill packs (84 active and 7 inactive pills). There is also a 365 day
pill pack.
A client is interested in taking a CHC (specifically a COC). As you perform a medication reconciliation,
you realize the client is taking phenytoin for seizures. Would you expect the provider to prescribe a
CHC for this client? Why or why not? Correct answer-No, a CHC should not be prescribed.
Anticonvulsants have been shown to interact with CHCs - especially oral contraceptives. The patch
and ring may have less of an interaction but it would be best to discuss different forms of
contraception since the medication will be used long term.
Generally speaking, which contraceptive methods are more effective and are less impacted by issues
with typical use? Correct answer-Long acting methods such as IUDs and the implant (also
permanent methods such as vasectomy and tubal ligation).
What are options for combined hormonal contraceptives (CHCs)? Correct answer-Combined oral
contraceptives
Contraceptive patch
Contraceptive ring
The progestin component of contraceptives also have what therapeutic action(s)? Correct answer-
Causes atrophy of the endometrium
Thickens the cervical mucus
Impairs fallopian tube motility and peristalsis
, Many of the side effects related to CHCs are due to the differences in the estrogen-progestin ratio.
What major side effects do excess estrogen and progestin cause? Correct answer-Excess estrogen -
Headache, Breast tenderness, Fluid retention
Excess progestin - Excess hair growth, Decreased breast size, Vaginitis
If the same client calls back after using the combined oral contraceptives for 4 months and still
reports breakthrough bleeding. The client desires to remain on pills. What action would you
anticipate the provider to take? Correct answer-Switch the client to an oral contraceptive with a
higher dose of estrogen since low estrogen is the leading cause of breakthrough bleeding.
What is the difference between biphasic and triphasic COCs? Correct answer-Biphasic - provide the
same amt of estrogen but progestin is increased halfway through the pill pack
Triphasic - have varying levels and estrogen each week. May be good for breakthrough bleeding but
increase risk for wt gain and mood changes.
A 36 yo client is seen in the clinic and desires a CHC. Their history reveals smoking 1 PPD for the past
10 years and prior VTE during pregnancy 7 years ago. Additionally, their aunt has a history of CVA. Is
this client a good candidate for a CHC? Why or why not? Correct answer-This client is not a good
candidate for anything that contains estrogen. The combination of estrogen, age > 35, smoking, and
prior history of VTE put this client at high risk for having another VTE. This client may be a candidate
for a progestin only contraceptive or a non-hormonal method. Personal history of CVA (not family
history) would be a contraindication for CHCs.
A client just received a prescription for a CHC. What very important education should be taught to
the client before taking a combined hormonal contraceptive? Correct answer-ACHES
A - severe abdominal pain
C - chest pain
H - headache
E - eye problems
S - severe leg pain
A client just received a prescription for a CHC. What are the 3 methods for starting a CHC? Correct
answer-First day method - start on first day of menstruation
Sunday start method - start on Sunday after the first day of menstruation
Quick start/same day method - start on same day client receives contraceptive -
As the nurse, you know that the quick start/same day method is generally preferred for starting CHCs
because there is a 25% chance that the client will not start the medication if the start date is delayed.
If you are educating a client about the quick start/same day method, what additional information do
you need to provide? Correct answer-If CHC is started within 5 days of menstruation, no back up
method/abstinence is needed.
If CHC is not started within 5 days of menstruation, use back up method/abstinence for 7 days.
A client calls the clinic and reports missing 1 of their COC pills. How would you advise this client?
Correct answer-Take the missed pill ASAP. Continue taking the remaining pills at the usual time.
No need for back up method/abstinence.
A client calls the clinic and reports missing 3 of their COC pills in a row. How would you advise this
client? Correct answer-Take the most recent missed pill ASAP. Any other missed pills should be
discarded.
CORRECT & VERIFIED ANSWERS (UPDATED TO PASS)
What is the difference between typical versus perfect use when discussing contraceptive methods?
Correct answer-Typical use - how effective contraception is when used well but not taken exactly as
prescribed (i.e. taking medication late or forgetting it)
Perfect use - how effective contraception is when used perfectly and exactly as prescribed
Other than pregnancy prevention, what are additional benefits of hormonal contraceptives?
Correct answer-Cycle regulation
Decrease ovarian cysts
Improve PMS and PMDD
Treatment of endometriosis
Prevention of ovarian and endometrial cancer
What is the main therapeutic action of estrogen and progestin (working together) in combined
hormonal contraceptive products? Correct answer-Suppression of folliculogenesis and suppression
of ovulation.
A client who is taking combined oral contraceptives (COCs) calls the clinic to report breakthrough
bleeding. The client has been taking the medication less than 6 weeks. What advice would you give
the client? Correct answer-Provide reassurance and encourage them to continue taking the
medication for at least 3 months to allow their body time to adjust to the hormones.
A client asks you if there are any COCs other than the traditional 21/7 formulation. How would you
respond? Correct answer-Yes, there are pills that have 24 or 26 days of active pills with only 4 or 2
inactive days. There are also 91 day pill packs (84 active and 7 inactive pills). There is also a 365 day
pill pack.
A client is interested in taking a CHC (specifically a COC). As you perform a medication reconciliation,
you realize the client is taking phenytoin for seizures. Would you expect the provider to prescribe a
CHC for this client? Why or why not? Correct answer-No, a CHC should not be prescribed.
Anticonvulsants have been shown to interact with CHCs - especially oral contraceptives. The patch
and ring may have less of an interaction but it would be best to discuss different forms of
contraception since the medication will be used long term.
Generally speaking, which contraceptive methods are more effective and are less impacted by issues
with typical use? Correct answer-Long acting methods such as IUDs and the implant (also
permanent methods such as vasectomy and tubal ligation).
What are options for combined hormonal contraceptives (CHCs)? Correct answer-Combined oral
contraceptives
Contraceptive patch
Contraceptive ring
The progestin component of contraceptives also have what therapeutic action(s)? Correct answer-
Causes atrophy of the endometrium
Thickens the cervical mucus
Impairs fallopian tube motility and peristalsis
, Many of the side effects related to CHCs are due to the differences in the estrogen-progestin ratio.
What major side effects do excess estrogen and progestin cause? Correct answer-Excess estrogen -
Headache, Breast tenderness, Fluid retention
Excess progestin - Excess hair growth, Decreased breast size, Vaginitis
If the same client calls back after using the combined oral contraceptives for 4 months and still
reports breakthrough bleeding. The client desires to remain on pills. What action would you
anticipate the provider to take? Correct answer-Switch the client to an oral contraceptive with a
higher dose of estrogen since low estrogen is the leading cause of breakthrough bleeding.
What is the difference between biphasic and triphasic COCs? Correct answer-Biphasic - provide the
same amt of estrogen but progestin is increased halfway through the pill pack
Triphasic - have varying levels and estrogen each week. May be good for breakthrough bleeding but
increase risk for wt gain and mood changes.
A 36 yo client is seen in the clinic and desires a CHC. Their history reveals smoking 1 PPD for the past
10 years and prior VTE during pregnancy 7 years ago. Additionally, their aunt has a history of CVA. Is
this client a good candidate for a CHC? Why or why not? Correct answer-This client is not a good
candidate for anything that contains estrogen. The combination of estrogen, age > 35, smoking, and
prior history of VTE put this client at high risk for having another VTE. This client may be a candidate
for a progestin only contraceptive or a non-hormonal method. Personal history of CVA (not family
history) would be a contraindication for CHCs.
A client just received a prescription for a CHC. What very important education should be taught to
the client before taking a combined hormonal contraceptive? Correct answer-ACHES
A - severe abdominal pain
C - chest pain
H - headache
E - eye problems
S - severe leg pain
A client just received a prescription for a CHC. What are the 3 methods for starting a CHC? Correct
answer-First day method - start on first day of menstruation
Sunday start method - start on Sunday after the first day of menstruation
Quick start/same day method - start on same day client receives contraceptive -
As the nurse, you know that the quick start/same day method is generally preferred for starting CHCs
because there is a 25% chance that the client will not start the medication if the start date is delayed.
If you are educating a client about the quick start/same day method, what additional information do
you need to provide? Correct answer-If CHC is started within 5 days of menstruation, no back up
method/abstinence is needed.
If CHC is not started within 5 days of menstruation, use back up method/abstinence for 7 days.
A client calls the clinic and reports missing 1 of their COC pills. How would you advise this client?
Correct answer-Take the missed pill ASAP. Continue taking the remaining pills at the usual time.
No need for back up method/abstinence.
A client calls the clinic and reports missing 3 of their COC pills in a row. How would you advise this
client? Correct answer-Take the most recent missed pill ASAP. Any other missed pills should be
discarded.
