Confusing homework question- what's your input?

[heatherhammy]

This question was on our homework and I really don't understand why the answer is what it is:

A nurse prepares to administer a newly prescribed medication to a 22 year old woman. The

medication package insert states that it is a “Category X” drug. Which is the nurse’s best

action?

A. Ask the patient, "Have you been sexually active during the past year?"

B. Ask the patient "When was your last menstraul period?"

C&D were obviously wrong

I chose A, because that would give a better indication of whether or not the patient could be pregnant. If they have not been sexually active, there's no point in asking about LMP. LMP may or may not tell you anything. Unless they are actually overdue for a period, then you wouldn't really know if they are pregnant. They could be pregnant but too early to take a test. Even if they *just* had a period, it could actually be early pregnancy bleeding. Knowing if they have been sexually active will clue you into whether or not you even need to be worried about LMP.

But the answer was B! What do you guys think?

[JBudd, MSN]

Becuase people lie all the time about sexual activity. You are overthinking the question.

LMP is a much less "threatening" question, and much more likely to get a straight forward answer.

[gumby1411]

Becuase people lie all the time about sexual activity.

This was my initial thought as well. Some people are reluctant to discuss their sexual activity with health care providers out of embarassement or shame, etc. They may not understand why the nurse needs to know their sexual history and may therefore, withhold this information.

Asking about LMP is a good jumping off point to determine if the patient may be pregnant. If the date of their LMP leads you to suspect they may be pregnant, then you can ask more questions to determine their sexual history. Or you can have them take a pregnancy test if they're unwilling to discuss their sexual history. Blood tests detect hCG sooner than urine tests (only by a day or two, but that can make the difference).

[Pneumothorax, BSN, RN]

You can also further question ab. Regularity and duration of their menstrual cycle to clue u in if they are infact pg.

Like the others said ppl lie about how much sex their having ESP if its a minor or they're embarrassed or anything like that

[DayDreamin ER CRNP]

Asking about someone's sexual activity is too vague and subjective and generally not an appropriate question in this situation. To a young patient, being sexually active may mean how many people she has had intercourse with which might make her feel defensive.

You need OBJECTIVE information before administering a Category X drug. Asking about a pt's LMP is the most appropriate question to ask.

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[~Mi Vida Loca~RN, ASN, RN]

So what do you ask after you ask for the LMP since someone can still have periods when pregnant or not have periods when not pregnant? I mean the question wouldn't simply be left at that right? ( seriously asking here, not being my normal smart aleck self!)

[MC1906]

Here is how I look at the question. Based on the information presented in the question, I would go with answer B.

Answer A: Would not choose this because category X is a medication that has known teratogenicity so knowing if the client is pregnant is the concern here. Having sex 11 months ago might not put you at risk when administering the risk today.

Answer B: better answer than A because it is more specific than A. If you wanted to know about spotting/bleeding, then ask that. You want to know if the patient, who is in childbearing age, could be pregnant so LMP is a typical question that is asked to get that information. Remember, this is a multiple choice question, not fill in the blank.

This question is testing your knowledge about Category X medication and pregnancy.

[CrunchyMama, ASN, RN]

I would've picked B...thank goodness, lol. I only would've picked this because it's usually what doctors/nurses ask. I don't think I've ever been asked if I've had sex in the last year, lol. LMP IS less in your business then a sex question. However I do understand why you picked A.

[Moogie]

So what do you ask after you ask for the LMP since someone can still have periods when pregnant or not have periods when not pregnant? I mean the question wouldn't simply be left at that right? ( seriously asking here, not being my normal smart aleck self!)

Very good question!

I would ask if there is any possibility whatsoever that the patient (oops, client) could be pregnant, if she is sexually active and what kind of contraception she uses. I think many providers require a blood pregnancy test before someone starts on a Category X drug because of the teratogenic effects.

This would be a good time to do some health teaching to instruct the client about using the most effective contraception available and explore her options if she would become pregnant. If she would be adamantly against abortion, even if there is a high risk for fetal deformities, it might be wise to prescribe a drug that has a lower potential risk.

[~Mi Vida Loca~RN, ASN, RN]

Thanks, I was just wondering because I have been asked many times if I have been sexually active. Almost routine anytime I go in for any kind of yearly and stuff. Also anytime I was having any procedure done that could be harmful if pregnant they automatically ran a pregnancy test first.