Clinical quiz - emergency contraception

Nurses in primary care play a key role in managing requests for emergency contraception. This requires evidence-based decision-making while supporting patients who may feel anxious, uncertain or pressed for time. Understanding the range of emergency contraception options, their indications and the factors that influence their effectiveness is an essential skill.

This clinical quiz uses patient scenarios to test and strengthen your knowledge of emergency contraception. The case-based questions explore appropriate choice of oral emergency contraception, when to recommend a copper intrauterine device and how factors such as timing of unprotected sexual intercourse, body weight medication use and ongoing contraception affect management decisions, in line with the latest guidance from the College of Sexual and Reproductive Health. It also discusses important aspects of patient counselling, safeguarding and addressing concerns if emergency contraception fails and pregnancy occurs.

Work your way through the questions and explanations to review your understanding of these core principles and build confidence in providing safe, patient-centred emergency contraception.

Click ‘start’ below to begin the quiz.

<section data-block="MultipleChoice"> <h3>Your first patient in an ANP clinic is Isobel, a 23-year-old woman who says that she has come for the ‘morning after pill’ as she had unprotected sex with her boyfriend the night before last. What options does she have for emergency contraception? Select all that apply</h3> <ul> <li>The copper intrauterine device (Cu-IUD).</li> <li>A single dose of 1.5mg levonorgestrel (LNG).</li> <li>The levonorgestrel intrauterine device (LNG-IUD).</li> <li>A single dose of 30mg ulipristal (UPA).</li> </ul> </section> <section data-block="SingleChoice"> <h3>You decide to take some more history from Isobel. Which of the following parts of the clinical assessment would be directly relevant to her choice of oral emergency contraception, if she declines a Cu-IUD?</h3> <ul> <li>Her weight and BMI.</li> <li>The fact that she takes a regular inhaled steroid for her asthma.</li> <li>The fact that she is breastfeeding.</li> <li>The fact that she takes levetiracetam for epilepsy, which is well controlled.</li> </ul> </section> <section data-block="SingleChoice"> <h3>Isobel is on day 12 of a regular 28-day cycle, she had UPSI the night before last and there have been no other episodes of UPSI. She takes the progestogen-only pill (desogestrel) for contraception but has missed three individual pills in the last seven days, taking the other four. She didn’t realise how absent minded she had been with her pills and so didn’t use a condom. She absolutely doesn’t want to have a Cu-IUD. She weighs 80kg and is 1.8m tall, giving her a BMI of 24.7.What oral EC should she take?</h3> <ul> <li>LNG at the usual dose of 1.5mg.</li> <li>UPA at the usual dose of 30mg.</li> <li>LNG at a double dose of 3mg.</li> <li>UPA at a double dose of 60mg.</li> </ul> </section> <section data-block="SingleChoice"> <h3>Your next patient is Adamma, a 35-year-old woman who has also come for EC. She is on day 17 of a regular 28-day cycle, and had UPSI on days 3, 8 and 11. What are her options?</h3> <ul> <li>She can’t use oral EC but can have a Cu-IUD because she is still within five days of the earliest likely date of ovulation.</li> <li>She has no EC options – a Cu-IUD could have been offered if she’d only had UPSI on day 11, but the UPSI earlier in the cycle means that it isn’t an option now.</li> <li>She could be given a packet of combined contraception and told to take two together to make a combined oral emergency contraceptive – this is unlicensed but recommended in guidelines.</li> </ul> </section> <section data-block="SingleChoice"> <h3>Later in the same day you see Shanti, a 30-year-old woman who has just found out that she is pregnant. She had UPSI and took UPA, but it didn’t work. She is considering her options and wants to know whether the UPA might have damaged her baby – if she decides to continue with the pregnancy, will she need any special monitoring?What do you tell her?</h3> <ul> <li>The chances of it having affected the baby are very small, but she will be offered extra scans just to be certain.</li> <li>All of the evidence to date suggests that there will be no effect, and she needn’t have any extra scans.</li> <li>She will be offered an early scan, because a pregnancy after the use of UPA is much more likely to be ectopic – if it is intrauterine then she can continue with the pregnancy as normal, with no extra scan.</li> <li>She should strongly consider a termination as the use of UPA in early pregnancy is associated with congenital heart disease.</li> </ul> </section> <p>  <p>  <p><strong>Related Article: </strong> <a id="related_article_link_2" href="https://www.nursinginpractice.com/clinical/womens-health/midlife-mandate-adding-menopause-to-nhs-health-checks-what-this-means-for-primary-care/">Midlife mandate: adding menopause to NHS health checks, what this means for primary care</a> <p>  <p>  <p>  <p><strong>Related Article: </strong> <a id="related_article_link_3" href="https://www.nursinginpractice.com/clinical/womens-health/what-is-menopause-washing-and-how-can-nurses-challenge-it/">What is ‘menopause washing’ and how can nurses challenge it?</a> <p>

Note all cases are hypothetical and developed for educational purposes

Clinical quiz – emergency contraception

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Clinical quiz – emergency contraception

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