Health Promotion and Maintenance Q 99
Which of the following instructions should be included in the nurse’s teaching regarding oral contraceptives?
A. Weight gain should be reported to the physician.
B. An alternate method of birth control is needed when taking antibiotics.
C. If the client misses one or more pills, two pills should be taken per day for 1 week.
D. Changes in the menstrual flow should be reported to the physician.
Correct Answer: B. An alternate method of birth control is needed when taking antibiotics.
When the client is taking oral contraceptives and begins antibiotics, another method of birth control should be used. Antibiotics decrease the effectiveness of oral contraceptives. Antibiotics are suspected to diminish oral contraceptive efficacy by two main mechanisms: induction of the cytochrome P450 group of hepatic microsomal enzymes and interference with enterohepatic cycling of ethinylestradiol.
Option A: Approximately 5–10 pounds of weight gain is not unusual. Women who stop taking the pill often do so because they think it has been causing them to gain weight. Clinical studies in this area are contradictory: Some women said that they gained weight, while others reported losing weight. This is why both weight gain and weight loss are listed as possible side effects on the product information of hormonal contraceptives.
Option C: If the client misses a birth control pill, she should be instructed to take the pill as soon as she remembers the pill. If she misses two, she should take two; if she misses more than two, she should take the missed pills but use another method of birth control for the remainder of the cycle.
Option D: Changes in menstrual flow are expected in clients using oral contraceptives. Often these clients have lighter menses. All hormonal contraceptives are associated with changes in menstrual bleeding patterns. When beginning a new hormonal contraception method, some people may experience irregular bleeding or spotting. Others may notice changes in the length or heaviness of bleeding, and some may stop bleeding entirely.