A client using a progestin-only injectable contraceptive (DMPA) asks the nurse about potential side effects. Which of the following is a common and important side effect associated with long-term DMPA use?
Significant increase in libido
Delayed return to fertility
Reduced risk of venous thromboembolism
Consistent and predictable menstrual cycles
The Correct Answer is B
Depot medroxyprogesterone acetate (DMPA) is a progestin-only injectable contraceptive administered every 12 weeks. It works by inhibiting ovulation, thickening cervical mucus, and altering the endometrium. A common and important side effect is delayed return to fertility, with ovulation resuming on average 9–10 months after the last injection. DMPA also causes menstrual irregularities, including amenorrhea. It may reduce bone mineral density with long-term use; normal bone mineral density (BMD) values are ≥1.0 g/cm². DMPA does not increase thromboembolic risk and is safe for women with estrogen contraindications. Other side effects include weight gain and mood changes.
Rationale for correct answers
2. DMPA is associated with a delayed return to fertility, often taking 9–10 months after the last injection for ovulation to resume. This is a well-documented and important counseling point for users considering future pregnancy.
Rationale for incorrect answers
1. DMPA does not cause a significant increase in libido. In fact, some users report decreased libido or mood changes. Libido effects vary and are not a consistent or prominent side effect.
3. While DMPA does not increase the risk of venous thromboembolism, this is not a side effect but rather a safety advantage. It is suitable for women with contraindications to estrogen, but the question asks for a side effect.
4. DMPA often causes unpredictable menstrual cycles, especially in the first year. Many users experience irregular bleeding or amenorrhea. Predictable cycles are not a feature of DMPA use.
Take home points
- DMPA delays return to fertility after discontinuation
- Menstrual irregularities are common with DMPA
- DMPA is safe for women with estrogen contraindications
- Bone density loss is a concern with long-term use
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Vasectomyis a permanent male sterilization procedure involving ligation or occlusion of the vas deferensto prevent sperm transport. It does not affect testosterone production, libido, or ejaculation volume. Post-procedure, residual sperm may persist in the distal reproductive tract for several weeks. Azoospermia, defined as absence of sperm in semen, must be confirmed via semen analysis, typically performed at 8–16 weeks post-procedure. Normal sperm concentration is ≥15 million/mL; azoospermia is <1000 sperm/mL or none detected. Vasectomy does not protect against STIsand is not guaranteed reversible.
Rationale for correct answers
2.Vasectomy requires follow-up semen analysis to confirm azoospermia. Sperm may remain in the ejaculatory ducts for weeks, and contraception must continue until semen is confirmed clear. This is essential for ensuring effectiveness and preventing unintended pregnancy.
Rationale for incorrect answers
1.Vasectomy is not immediately effective. Sperm distal to the occlusion site can persist for up to 20 ejaculations or several weeks. Immediate reliance on vasectomy without confirmation risks pregnancy.
3.Vasectomy does not reduce STI risk. It only prevents sperm transport, not transmission of infectious agents. Barrier methods like condoms are still required for STI protection.
4.Vasectomy is considered permanent. While reversal is possible via vasovasostomy or vasoepididymostomy, success rates vary and are not guaranteed. Reversal is complex, costly, and not universally successful.
Take home points
- Vasectomy requires semen analysis to confirm azoospermia before discontinuing contraception.
- It is not immediately effective post-procedure.
- It does not protect against STIs.
- Reversal is possible but not guaranteed; vasectomy should be considered permanent.
Correct Answer is ["A","C","D"]
Explanation
Hormonal intrauterine devices (IUDs)such as levonorgestrel-releasingsystems (e.g. Mirena) are long-acting reversible contraceptivesthat deliver localized progestinto the endometrium. They suppress endometrial proliferation, reduce menstrual bleeding, and alleviate dysmenorrhea. Mirena releases 20 µg/day of levonorgestrel and is effective for up to 5 to 8 years. It does not contain estrogen, making it suitable for women with contraindications to estrogen. Hormonal IUDs do not protect against STIs. Normal menstrual blood loss is <80 mL per cycle; Mirena can reduce this by up to 90%.
Rationale for correct answers
1.Hormonal IUDs significantly reduce menstrual bleeding and dysmenorrhea by thinning the endometrial lining and suppressing prostaglandin synthesis. Clinical trials show up to 90% reduction in menstrual blood loss.
3.Hormonal IUDs provide long-acting contraception with failure rates <1% per year. Mirena is effective for up to 8 years, requiring no user action after insertion.
4.Hormonal IUDs contain only progestin, not estrogen. They are suitable for women with estrogen-sensitive conditions such as migraine with aura, thromboembolic disorders, or hypertension.
Rationale for incorrect answers
2.Hormonal IUDs do not offer protection against STIs. They act locally to prevent pregnancy but do not form a barrier to infectious agents. Barrier methods are still required for STI prevention.
5.Hormonal IUDs do not require daily attention or insertion. They are placed once by a provider and remain effective for years. Daily maintenance is unnecessary and not part of their mechanism.
Take home points
- Hormonal IUDs reduce menstrual bleeding and dysmenorrhea.
- They are highly effective and long-acting.
- Suitable for women who cannot use estrogen.
Do not protect against STIs; condoms are still needed.
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