KR is a 22 y/o female, 210lbs, no known allergies, and you are preparing to prescribe her contraception. She has a strong family history for osteoporosis. She is not on any medications but states she had a very hard time remembering to take pills. She is not interested in getting pregnant for at least 3 years or more. Which mode of delivery would be the best for KR? Select one:
Norethidrone TABLETS daily (progestin only pills)
Etonogestrel IMPLANT once; remove in 3 years (Nexplanon)
Medroxyprogesterone INTRAMUSCULAR q3 months (Depo-Provera)
Ethinyl Estradiol and Norelgestromin PATCH weekly (Xulane)
The Correct Answer is B
Contraceptive selection should consider effectiveness, duration of action, patient adherence, comorbid risks, and future pregnancy plans. Long-acting reversible contraception is often preferred for patients who have difficulty remembering daily medications and who desire reliable pregnancy prevention for several years. Family history and medication side effects must also be considered when choosing the safest option. In this case, bone health and adherence are important factors guiding the best contraceptive choice.
Rationale:
A. Norethindrone tablets require strict daily adherence at nearly the same time each day to maintain contraceptive effectiveness. Since the patient reports difficulty remembering pills, this option would increase the risk of missed doses and unintended pregnancy. Although it avoids estrogen-related concerns, poor adherence makes it a less suitable long-term choice for this patient.
B. Etonogestrel implant (Nexplanon) is the best option because it provides highly effective contraception for up to 3 years with a single placement and requires no daily or frequent maintenance. It is ideal for patients who struggle with medication adherence and want long-term pregnancy prevention. It also avoids the bone mineral density concerns associated with depot medroxyprogesterone, making it more appropriate given her strong family history of osteoporosis.
C. Medroxyprogesterone (Depo-Provera) is effective and does not require daily adherence, but long-term use is associated with decreased bone mineral density. Since the patient has a strong family history of osteoporosis, this is less desirable, especially when safer long-acting alternatives are available. The need for repeat injections every 3 months also adds maintenance requirements compared to an implant.
D. Ethinyl estradiol and norelgestromin patch (Xulane) requires weekly application and consistent replacement to remain effective. While easier than daily pills, it still depends on regular patient adherence. In addition, contraceptive patch effectiveness may be reduced in patients with higher body weight, and at 210 pounds, this may reduce reliability compared to a long-acting implant option.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Recurrent urinary tract infections (UTIs) with systemic symptoms suggest a more complicated infection, possibly involving upper urinary tract involvement such as pyelonephritis or resistant organisms. Treatment selection must consider local antimicrobial resistance patterns, severity of symptoms, and prior antibiotic exposure. Broader-spectrum antibiotics are often required when resistance is a concern or when infection is not limited to the lower urinary tract. Therapy duration is also extended in more complex presentations.
Rationale:
A. Ciprofloxacin (Cipro) is an appropriate option in this scenario because it provides broad-spectrum coverage against common urinary pathogens and achieves good tissue penetration, including renal tissue. In a patient with recurrent UTI and systemic symptoms, there is concern for resistant organisms or upper tract involvement, making fluoroquinolones a reasonable choice when resistance patterns support their use. A 7-day course is consistent with treatment for complicated infection.
B. Trimethoprim-sulfamethoxazole (Bactrim) is typically used for uncomplicated cystitis with a short 3-day course when local resistance rates are low. However, in recurrent infections with systemic symptoms and concern for resistance, it may be ineffective due to increasing E. coliresistance. It is not the best empiric choice in this higher-risk presentation.
C. Clarithromycin (Biaxin) is not appropriate for urinary tract infections because it has poor activity against common uropathogens such as E. coli. Macrolides are primarily used for respiratory and certain atypical infections, not urinary tract infections. Therefore, it would not provide adequate empiric coverage in this case.
D. Fosfomycin (Monurol) is used as a single-dose therapy for uncomplicated lower urinary tract infections. It is not appropriate for recurrent UTIs with systemic symptoms or suspected upper urinary tract involvement. Its limited systemic penetration makes it unsuitable for more complicated or resistant infections.
Correct Answer is C
Explanation
Migraine is a neurovascular disorder characterized by episodic headache often accompanied by nausea, photophobia, and phonophobia. Abortive (acute) therapy aims to stop or reduce symptoms once a migraine begins. First-line treatment for mild to moderate or “simple” migraines typically includes nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce prostaglandin-mediated inflammation and pain. Early administration improves effectiveness and may prevent progression of symptoms.
Rationale:
A. Butalbital/acetaminophen/caffeine (Fioricet) is not considered first-line therapy for migraines due to its risk of dependence, medication-overuse headache, and sedation. It is generally reserved for refractory cases and is not preferred for routine abortive migraine management. Its barbiturate component increases risk of tolerance and rebound headaches.
B. Butorphanol nasal spray (Stadol NS) is an opioid agonist-antagonist and is not recommended for first-line migraine therapy. Opioids are generally avoided in migraine management due to high risk of dependence, medication-overuse headaches, and inferior efficacy compared to NSAIDs and triptans. It is reserved only for rare, refractory cases when other treatments fail.
C. Naproxen (Aleve) is a first-line abortive treatment for simple migraines because it reduces inflammation and pain by inhibiting cyclooxygenase enzymes and prostaglandin synthesis. It is effective for mild to moderate migraine attacks and is widely recommended due to its safety, accessibility, and efficacy when taken early in the migraine episode.
D. Meperidine (Demerol) is not appropriate for migraine management due to its addictive potential and association with poor headache outcomes, including rebound headaches. Opioids are not recommended for routine migraine treatment and are reserved only for exceptional circumstances when other therapies are ineffective or contraindicated.
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