Question 1

A patient has been diagnosed with an incompetent cervix (the cervix will not remain closed). What treatment option will be incorporated into the plan of care for this patient?

Accepted Answer

An incompetent cervix would place the patient in a high-risk category, and more frequent ultrasound monitoring would be included in her care plan. Although bed rest may be ordered, there is conflicting evidence regarding the merits of this intervention. An incompetent cervix is considered a clinical abnormality, therefore the standard of care requires appropriate surgical intervention. A cerclage procedure is typically done much earlier in the pregnancy period.

Question 2

Which situation best describes secondary infertility in a couple?

Accepted Answer

Secondary infertility occurs in couples that have conceived before; but, are unable to conceive again. Primary infertility occurs when a couple has never conceived or who has not conceived after 1 year of unprotected intercourse (6 months if the women is over age 35). Repeated spontaneous abortions are considered primary infertility (pregnancy wastage).

Question 3

Chromosome analysis is a diagnostic test that should be offered to which couple?

Accepted Answer

Repeated failures to carry a pregnancy to term may indicate genetic defects in the fetus that are incompatible with life. A couple that has never conceived would not be offered chromosome analysis. Long-standing infertility is not an indicator for chromosome analysis. Secondary infertility with an existing normal child would not be an indicator for chromosome analysis.

Question 4

Large amounts of leukocytes in the seminal fluid suggest a clinical finding of

Accepted Answer

The presence of large amounts of leukocytes suggests an infection. Adequate fructose must be present to supply energy for the sperm. An inflammatory process would be diagnosed by abnormal consistency or chemical composition. If an obstruction is present, the total amount of seminal fluid would be decreased.

Question 5

A couple who has not achieved a successful pregnancy is scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed?

Accepted Answer

Semen analysis is usually the first test to be performed because it is least costly and noninvasive. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. A testicular biopsy is an invasive examination using a local anesthetic. Hysterosalpingography uses a contrast medium to evaluate the structure and patency of the uterus and tubes.

Question 6

Which factors would contribute to abnormalities of the fallopian tube associated with the development of infertility? (Select all that apply.)

Accepted Answer

Surgical procedures related to the cervix, along with an incompetent cervix, would not affect the fallopian tubes in terms of infertility. It would affect fertility issues related to the cervix as a result of potential scarring (conization) and an inability to maintain the pregnancy in the presence of an incompetent cervix. A history of pelvic surgical procedures could result in the development of pelvic adhesions, which would affect the fallopian tube. Also, the presence of STDs, even with effective treatment, along with the clinical diagnosis, would affect the fallopian tube and possibly result in infertility.

Question 7

A woman who is undergoing infertility testing states, "My husband won't discuss this with me. I don't think he cares about or wants a baby." The nurse's ideal response is

Accepted Answer

Men often internalize their feelings, which may appear to women as lack of concern or interest. Suggesting that the woman confront her husband suggests that the woman is at fault and not communicating with her husband. "He probably doesn't understand your concern" does not explain to the woman why her husband won't discuss the problem; it passes judgment on the husband. "Men are sometimes less eager to have children" does not allow the woman to express her feelings; it offers the nurse's opinion, which is not appropriate.

Question 8

Which of the following medical conditions could possible affect a woman's fertility status?

Accepted Answer

Women with polycystic ovarian syndrome (PCOS) often have challenges conceiving in addition to other problems due to abnormal hormones and ovarian function. The use of inhaler therapy for the treatment of asthma should not affect the patient's fertility status. Removal of external polyps on the labia should not affect the patient's fertility. A history of sinus headaches should not affect the patient's fertility.

Question 9

The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus is

Accepted Answer

In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination, also known as intrauterine insemination, uses the partner's sperm or that of a donor and places it directly into the uterus. Gamete intrafallopian transfer is when the sperm and ova are placed in the fallopian tube.

Question 10

A newly married woman states, "My friend told me I would never have a baby because I had pelvic inflammatory disease when I was younger. I don't understand how that can affect whether or not I get pregnant." The nurse's most appropriate response is

Accepted Answer

Providing the patient with accurate complete information is the best response. If untreated, pelvic inflammatory disease produces scarring and obstruction of the fallopian tube. Tubal scarring and obstruction do not occur following gonorrhea.

Question 11

Which adverse reactions are associated with the administration of clomiphene citrate (Clomid)? (Select all that apply.)

Accepted Answer

Some adverse reactions associated with Clomid are abdominal distension, frequent urination, nausea and vomiting, and abnormal uterine bleeding. Diarrhea is not a common presentation.

Question 12

A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests, we will know what is wrong." The nurse's best response is

Accepted Answer

Problems with infertility must be approached realistically. Nurses should not make judgments or provide false reassurance. Providing accurate information to the couple is the optimal response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive; therefore, the nurse should not offer her view or opinion; rather, should state the facts.

Quiz 26: Infertility

A patient has been diagnosed with an incompetent cervix (the cervix will not remain closed) . What treatment option will be incorporated into the plan of care for this patient?