What is the primary reason why combined hormonal contraceptives are often contraindicated for women who smoke and are over the age of 35?
Decreased effectiveness of the contraceptive due to smoking
Increased risk of bone mineral density loss
Significantly elevated risk of venous thromboembolism, myocardial infarction, and stroke
Higher incidence of irregular bleeding and spotting
The Correct Answer is C
Combined hormonal contraceptives (CHCs) contain estrogen and progestin, and are widely used for pregnancy prevention, cycle regulation, and acne management. In women over 35 who smoke, CHCs are contraindicated due to a synergistic increase in cardiovascular risk. Estrogen promotes hepatic synthesis of clotting factors, increasing the risk of venous thromboembolism (VTE). Smoking accelerates atherogenesis, raising the risk of myocardial infarction and stroke. The baseline VTE risk in reproductive-age women is approximately 1–5 per 10,000 annually; CHCs increase this to 9–10 per 10,000, and smoking compounds it further. Blood pressure should be <140/90 mmHg before initiating CHCs.
Rationale for correct answers
3. Women over 35 who smoke have a significantly elevated risk of thrombotic events when using CHCs. Estrogen increases clotting factor production, and smoking promotes endothelial damage and platelet aggregation. Together, they markedly increase the risk of VTE, myocardial infarction, and stroke.
Rationale for incorrect answers
1. Smoking does not reduce the effectiveness of CHCs. The contraceptive efficacy remains high (>99% with perfect use), and metabolism of hormones is not significantly altered to reduce effectiveness.
2. Bone mineral density loss is associated with long-term use of depot medroxyprogesterone acetate (DMPA), not CHCs. Estrogen in CHCs actually helps maintain bone density.
4. Irregular bleeding and spotting are more common with progestin-only methods or during initial CHC use, but not a primary contraindication in smokers over 35. The cardiovascular risk is the dominant concern.
Take home points
- CHCs are contraindicated in women >35 who smoke due to elevated cardiovascular risk.
- Estrogen increases clotting factors; smoking promotes vascular injury.
- CHCs do not reduce bone density; DMPA does.
- CHCs remain highly effective regardless of smoking status.
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
Lactational amenorrhea method (LAM)is a temporary contraceptive strategybased on exclusive breastfeeding, amenorrhea, and infant age <6 months. It relies on prolactin-mediated suppressionof the hypothalamic-pituitary-ovarian axis, inhibiting gonadotropin-releasing hormone (GnRH)and thus ovulation. For LAM to be effective, breastfeeding must be frequent, including night feeds, and the mother must remain amenorrheic. Normal prolactin levels during lactation range from 100 to 400 ng/mL; elevated levels suppress GnRH. Once menstruation resumes or supplementation begins, contraceptive efficacy declines sharply.
Rationale for correct answers
1.Exclusive or near-exclusive breastfeeding maintains high prolactin levels, which suppress ovulation. Introduction of formula or solids reduces prolactin and compromises contraceptive efficacy.
3.LAM is only effective if the infant is <6 months old. After 6 months, complementary feeding begins and ovulatory cycles may resume, reducing reliability.
4.Frequent breastfeeding, including night feeds, sustains prolactin levels. Infrequent nursing allows prolactin to drop, increasing risk of ovulation and pregnancy.
Rationale for incorrect answers
2.Resumption of menses indicates return of ovulatory cycles. LAM is no longer effective once menstruation occurs, even if breastfeeding continues.
5.Regular formula supplementation reduces breastfeeding frequency and prolactin levels. This undermines the hormonal suppression of ovulation, making LAM ineffective.
Take home points
- LAM requires exclusive breastfeeding, amenorrhea, and infant age <6 months.
- Resumption of menses or formula use invalidates LAM.
- Frequent day and night breastfeeding maintains contraceptive efficacy.
- LAM is a temporary method and must transition to other contraception after 6 months.
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