Clinical quiz - contraception in teenagers

Nurses in primary care will often be the first port of call for teenagers wishing to seek help with decisions around contraception. These consultations require sensitivity and patience as well as clear understanding of both legal and clinical considerations.

This case-based quiz will test and refresh your knowledge of the key legal, ethical and clinical principles, including Fraser guidance, confidentiality, safeguarding concerns, online access to records and contraceptive choices for young people, in line with current guidance including the College of Sexual and Reproductive Healthcare guidelines.

Work your way through the questions and explanations to review and refresh your understanding of teenage contraception and safeguarding.

Click ‘start’ below to begin the quiz.

<div id="article_leaderboard2" class="article-lb mb-4 widget_text widget adbanner mpu d-none d-md-none d-lg-block "> <div class="textwidget custom-html-widget">  <div id="article-lb"><script> googletag.cmd.push(function() { googletag.display("article_leaderboard2"); }); </script></div> </div> </div> <section data-block="SingleChoice"> <h3>Nicola, aged 14, has come to see you about heavy periods, accompanied by her mother, in your ANP clinic.You discuss the various options, and as per your usual practice when seeing teenagers, you ask her mother to sit in the waiting room for 5 minutes so that you can see Nicola alone.You ask her if there’s anything that she wants to tell you that she can’t say in front of her mother and she looks relieved and says that she doesn’t actually have heavy periods, but she has a boyfriend and is thinking about having sex – she’d like to go on the pill and has heard that it is sometimes given for heavy periods, which is why she is here.Can you give this patient the pill and not tell her mother?</h3> <ul> <li>Yes – it is undoubtedly in her best interests not to get pregnant.</li> <li>No – she’s below the age of consent and it would be illegal now that you know what she wants it for.</li> <li>I’d need to know more before making a decision.</li> </ul> </section> <section data-block="MultipleChoice"> <h3>You remember the term ‘Gillick competence’ from your training, and that there are five points which need to be proven for a young person to be competent to give consent to contraception and sexual health advice. Which of the following are included in these five points? Select all that apply</h3> <ul> <li>There is an age difference of no more than three years between the sexual partners.</li> <li>You cannot persuade the young person to tell their parents or allow you to tell them.</li> <li>The older partner is not in a position of authority over the younger one.</li> <li>It is in the best interests of the young person to receive advice or treatment without the knowledge of their parents.</li> <li>There is no evidence of grooming in the relationship.</li> </ul> </section> <section data-block="SingleChoice"> <h3>The Fraser guidance represents the minimum amount of information that you would need to get from Nicola – as such, the wrong answers in the previous multiple choice question are still relevant things to ask, they just don’t form part of Fraser guidance. Any suggestion of grooming, the use of drugs or alcohol, non-consensual sex, controlling behaviour from her partner or an imbalance of age or power would be very concerning. How does the age of consent differ if her partner was, for example, her tennis coach?</h3> <ul> <li>No difference – it would still be legal for them to have sex once Nicola turns 16.</li> <li>The age of consent would rise to 17.</li> <li>The age of consent would rise to 18.</li> <li>The age of consent would rise to 21.</li> </ul> </section> <section data-block="MultipleChoice"> <h3>You take a further history from Nicola. She has been going out with her boyfriend for six months. He is in her class at school, and they have been friends since primary school. There is nothing to suggest any grooming or coercion – she has never drunk alcohol or taken any drugs and he is her first boyfriend. She isn’t certain that she wants to have sex now but would like to be protected in case she does – but he isn’t pressuring her, in fact she thinks that he is more nervous than her at the idea. She doesn’t want to tell her mother, but she does have adult support as she has confided in an older cousin. You explain to Nicola how to take the pill and what to do if she misses a pill and is having sex, and advise about the importance of condoms and where she can access them for free, and also that she can make an appointment on her own at any time. You then bring her mother back in and prescribe the pill, ostensibly to treat Nicola’s heavy periods. You arrange a review in 3 months. Her mother thanks you and says that after that review she will re-order it via the NHS app when it runs out, as she has access for Nicola. You realise that this means that her mother can see today’s consultation notes and that this could inadvertently breach Nicola’s confidentiality.Which of the following are reasonable options to prevent this? Select all that apply</h3> <ul> <li>Mark today’s consultation as not for online access.</li> <li>Tell Nicola’s mother that only Nicola can have access to her notes, as that is surgery policy for children who are 14 or over.</li> <li>Only document the discussion about heavy periods, and not the discussion about her relationship.</li> <li>Only document the discussion about heavy periods in the notes but keep your own notes elsewhere about the rest of the consultation.</li> </ul> </section> <section data-block="SingleChoice"> <h3>You are aware that the pill has a high real-life failure rate. Could you have offered Nicola a more effective and long-acting method of contraception?</h3> <ul> <li>No – legally those aged under 16 cannot use long-acting contraception.</li> <li>Yes, you could have offered her an implant, but the intrauterine device (IUD) is absolutely contraindicated under the age of 16.</li> <li>Yes, she could have the same range of contraception as an adult.</li> </ul> </section> <p>  <p>  <p>  <p>  <p>

Note cases in this series are hypothetical and developed for educational purposes

Clinical quiz – contraception in teenagers

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Clinical quiz – contraception in teenagers

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