Question 1

What should the nurse be aware of with regard to the assessment of female,male,and couple infertility?

Accepted Answer

Fertility assessment and diagnosis take time,money,and commitment from the couple.Religious,cultural,and ethnic-bred attitudes about fertility and related issues always have an impact on diagnosis and assessment.Both partners are assessed systematically and simultaneously,as individuals and as a couple.Semen analysis is for men,but the postcoital test is for the couple.

Question 2

A man smokes two packs of cigarettes a day.He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant.What is the nurse's most appropriate response?

Accepted Answer

Use of tobacco,alcohol,and marijuana may affect sperm counts."Your sperm count seems to be okay in the first semen analysis" is inaccurate.Sperm counts vary from day to day and depend on emotional and physical status and sexual activity.Therefore,a single analysis may be inconclusive.A minimum of two analyses must be performed several weeks apart to assess male fertility.

Question 3

A woman was treated recently for toxic shock syndrome (TSS).She has intercourse occasionally and uses over-the-counter protection.On the basis of her history,which contraceptive method should she and her partner avoid?

Accepted Answer

Women with a history of TSS should not use a cervical cap.Condoms,vaginal films,and vaginal sheaths are not contraindicated for a woman with a history of TSS.

Question 4

A couple is trying to cope with an infertility problem.They want to know what they can do to preserve their emotional equilibrium.What is the nurse's most appropriate response?

Accepted Answer

Venting negative feelings may unburden the couple.A support group may provide a safe haven for the couple to share their experiences and gain insight from others' experiences.Although talking about their feelings may unburden them of negative feelings,infertility can be a major stressor that affects the couple's relationships with family and friends.Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs,but depending on where the other couple is in their own recovery process,this may or may not help them.The statement about adoption proceedings is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

Question 5

A woman has chosen the calendar method of conception control.During the assessment process,what is most important for the nurse to do?

Accepted Answer

The calendar method of conception control is based on the number of days in each cycle,counting from the first day of menses.The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months.Weight gain or loss may be partly related to hormonal fluctuations,but it has no bearing on use of the calendar method.Integumentary changes may be related to hormonal changes,but they are not indicators for use of the calendar method.Exploring previous experiences with conception control may demonstrate patient understanding and compliancy,but it is not the most important aspect to assess for discussion of the calendar method.

Question 6

Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?

Accepted Answer

Endometrial biopsy is scheduled after ovulation,during the luteal phase of the menstrual cycle.A hysterosalpingogram is scheduled in the early proliferative phase to avoid flushing potentially fertilized ovum out through a uterine tube into the peritoneal cavity.Laparoscopy usually is scheduled early in the menstrual cycle.Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

Question 7

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide).What is the nurse's most appropriate response?

Accepted Answer

Nonoxynol-9 does not provide protection against sexually trAnswermitted infections; it has also been linked to an increase in the trAnswermission of HIV and can cause genital lesions.Nonoxynol-9 may cause vaginal irritation.Nonoxynol-9 has no effect on the quality of sexual activity.Nonoxynol-9 has no effect on penile sensitivity.

Question 8

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice.What is the nurse's most appropriate response?

Accepted Answer

"Your current medications will reduce the effectiveness of the pill" is a true statement.It is not highly effective for her because the liver metabolizes oral contraceptives and their effectiveness is reduced when they are taken simultaneously with anticonvulsants.The anticonvulsant will reduce the effectiveness of the pill,not the other way around."This is a good choice for a woman of your age and personal history" does not teach the patient that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

Question 9

A woman is 16 weeks pregnant and has elected to terminate her pregnancy.Which is the most common technique used for medical termination of a pregnancy in the second trimester?

Accepted Answer

The most common technique for medical termination of a pregnancy in the second trimester is D&E.It is usually performed between 14 and 18 weeks.Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use.Intravenous administration of oxytocin is used to induce labour in a woman with a third-trimester fetal demise.Vacuum aspiration is used for abortions in the first trimester.

Question 10

Although remarkable developments have occurred in reproductive medicine,assisted reproductive therapies are associated with a number of legal and ethical issues.Nurses can provide accurate information about the risks and benefits of treatment alternatives so that couples can make informed decisions about their choice of treatment.Which issue would need to be addressed by an infertile couple before treatment?

Accepted Answer

The risk of multiple gestations is indeed a risk of treatment that the couple needs to be aware of.In order to minimize the chance of multiple gestations,generally only three or fewer embryos are trAnswerferred.The couple should be informed that there may be a need for multifetal reduction.Nurses can provide anticipatory guidance on this matter.Although the method of payment is important,obtaining this information is not the responsibility of the nurse.All provinces in Canada provide coverage for diagnostic testing and some medical treatment.Teaching regarding disclosure of the facts of conception should provide neutral information and not assume that the couple only wants information on how to avoid disclosure.It is possible to freeze embryos for later use.Couples who have excess embryos frozen for later trAnswerfer must be fully informed before consenting to the procedure.A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time.

Question 11

An unmarried young woman describes her sex life as "active" and involving "many" partners.She wants a contraceptive method that is reliable and does not interfere with sex.She requests an intrauterine device ( IUD ).What is the nurse's most appropriate response?

Accepted Answer

Disadvantages of IUDs include an increased risk of PID in the first 20 days after insertion and the risks of bacterial vaginosis and uterine perforation.The IUD offers no protection against STIs or the human immunodeficiency virus.Because this woman has multiple sex partners,she is at higher risk of developing an STI.The IUD does not protect against infection,as does a barrier method.Although the statement "The IUD does not interfere with sex" may be correct,it is not the most appropriate response.The IUD offers no protection from STIs.The typical failure rate of the IUD ranges from 0.8 to 2%.

Question 12

When working with patients who are experiencing infertility,the nurse should be aware of which of the following related to infertility?

Accepted Answer

Women tend to be more stressed about infertility tests and to place more importance on having children.The prevalence of infertility is stable among the overall population,but it increases with a woman's age,especially over age 40.Of cases with an identifiable cause,about 40% are related to female factors,40% to male factors,and 20% to both partners.Sterility is the inability to conceive.Infertility is a state of requiring a prolonged time to conceive,or subfertility.

Question 13

In vitro fertilization-embryo transfer (IVF-ET)is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts.A husband and wife have arrived for their preprocedural interview.The husband asks the nurse to explain what the procedure entails.What is the nurse's most appropriate response?

Accepted Answer

A woman's eggs are collected from her ovaries,fertilized in the laboratory with sperm,and trAnswerferred to her uterus after normal embryonic development has occurred.The statement "A donor embryo will be trAnswerferred into your wife's uterus" describes therapeutic donor insemination."Donor sperm will be used to inseminate your wife" describes the procedure for a donor embryo."Don't worry about the technical stuff; that's what we are here for" discredits the patient's need for teaching and is not the most appropriate response.

Question 14

A couple comes in for an infertility workup,having attempted to get pregnant for 2 years.The woman,37,has always had irregular menstrual cycles but is otherwise healthy.The man has fathered two children from a previous marriage and underwent a vasectomy reversal 2 years ago.The man has had two normal semen analyses,but the sperm seem to be clumped together.What additional test is needed?

Accepted Answer

The woman has irregular menstrual cycles.The scenario does not indicate that she has had any testing related to this irregularity.Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.Determination of blood levels of prolactin,FSH,luteinizing hormone (LH),estradiol,progesterone,and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles.A testicular biopsy would be indicated only in cases of azoospermia (no sperm cells)or severe oligospermia (low number of sperm cells).Antisperm antibodies are produced by a man against his own sperm.This is unlikely to be the case here,because the husband has already produced children.Examination for testicular infection would be done before semen analysis.Furthermore,infection would affect spermatogenesis.

Question 15

Injectable progestins ( DMPA,Depo-Provera )are a good contraceptive choice for which of the following women?

Accepted Answer

Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives,with the requirement of only four injections a year; therefore,women who have difficulty remembering to take a daily pill will find this method attractive.Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding.Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism.To be effective,DMPA injections must be administered every 11 to 13 weeks.Access to health care is necessary to prevent pregnancy or potential complications.

Question 16

A woman is using the basal body temperature (BBT)method of contraception.She calls the clinic and tells the nurse,"My period is due in a few days,and my temperature has not gone up." What is the nurse's most appropriate response?

Accepted Answer

A pattern of lower body temperature with no increase is most likely is the result of lack of ovulation.Pregnancy cannot occur without ovulation (which is being measured using the BBT method).A comment such as "Don't worry; it's probably nothing" discredits the patient's concerns.Illness would most likely cause an increase in basal body temperature.

Question 17

A woman inquires about herbal alternative methods for improving fertility.Which statement by the nurse is most appropriate when instructing the patient about which herbal preparations to avoid while trying to conceive?

Accepted Answer

Herbs that a woman should avoid while trying to conceive include licorice root,yarrow,wormwood,ephedra,fennel,goldenseal,lavender,juniper,flaxseed,pennyroyal,passionflower,wild cherry,cascara,sage,thyme,and periwinkle.Nettle leaf,dong quai,and vitamin E are all remedies that promote fertility.Vitamin E,calcium,and magnesium may promote fertility and conception.

Question 18

A woman currently uses a diaphragm and spermicide for contraception.She asks the nurse what the major differences are between the cervical cap and diaphragm.What is the nurse's most appropriate response?

Accepted Answer

The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later.No additional spermicide is required for repeated acts of intercourse.Spermicide should be used inside the cap as an additional chemical barrier.The cervical cap should remain in place for 6 hours after the last act of intercourse.Repeated intercourse with the cervical cap is more convenient,because no additional spermicide is needed.

Question 19

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs).What is the nurse's most appropriate response?

Accepted Answer

FAMs are effective with proper vigilance about ovulatory changes in the body and adherence to coitus intervals and strict record keeping.They are effective if used correctly by a woman with a regular menstrual cycle.FAMs have no health risks other than pregnancy.The use of birth control has associated health risks; this response disregards the patients' question and provides false reassurance.

Question 20

What should the nurse do when implementing a plan of care for infertile couples?

Accepted Answer

Nurses should be open to and ready to help with a variety of pharmacological and non-pharmacological approaches.They should practice in a nonjudgemental manner at all times.When implementing a plan of care for infertile couples the nurse should engage in discussions of lifestyle changes that may enhance fertility rather than avoid discussing them.Before the nurse promotes the use of herbs it is important that the couple`s readiness for herbal remedies be assessed.

Quiz 7: Infertility, contraception, and Abortion

What should the nurse be aware of with regard to the assessment of female,male,and couple infertility?

A man smokes two packs of cigarettes a day.He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant.What is the nurse's most appropriate response?

A woman was treated recently for toxic shock syndrome (TSS) .She has intercourse occasionally and uses over-the-counter protection.On the basis of her history,which contraceptive method should she and her partner avoid?

A couple is trying to cope with an infertility problem.They want to know what they can do to preserve their emotional equilibrium.What is the nurse's most appropriate response?

A woman has chosen the calendar method of conception control.During the assessment process,what is most important for the nurse to do?

Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide) .What is the nurse's most appropriate response?

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice.What is the nurse's most appropriate response?

A woman is 16 weeks pregnant and has elected to terminate her pregnancy.Which is the most common technique used for medical termination of a pregnancy in the second trimester?

An unmarried young woman describes her sex life as "active" and involving "many" partners.She wants a contraceptive method that is reliable and does not interfere with sex.She requests an intrauterine device ( IUD ) .What is the nurse's most appropriate response?

When working with patients who are experiencing infertility,the nurse should be aware of which of the following related to infertility?

Injectable progestins ( DMPA,Depo-Provera ) are a good contraceptive choice for which of the following women?

A woman is using the basal body temperature (BBT) method of contraception.She calls the clinic and tells the nurse,"My period is due in a few days,and my temperature has not gone up." What is the nurse's most appropriate response?

A woman inquires about herbal alternative methods for improving fertility.Which statement by the nurse is most appropriate when instructing the patient about which herbal preparations to avoid while trying to conceive?

A woman currently uses a diaphragm and spermicide for contraception.She asks the nurse what the major differences are between the cervical cap and diaphragm.What is the nurse's most appropriate response?

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs) .What is the nurse's most appropriate response?

What should the nurse do when implementing a plan of care for infertile couples?