Question 1

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.The nurse's most appropriate response is:

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.A single analysis may be inconclusive.A minimum of two analyses must be performed several weeks apart to assess male fertility.

Question 2

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).The nurse's most appropriate response is:

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 human immunodeficiency virus.Because this woman has multiple sex partners,she is at higher risk of developing a 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 in the first year of use is 0.8%.

Question 3

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.The nurse's most appropriate response is:

Accepted Answer

A woman's eggs are collected from her ovaries,fertilized in the laboratory with sperm,and transferred to her uterus after normal embryonic development has occurred.The statement,"A donor embryo will be transferred 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 an inappropriate response.

Question 4

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,what 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 5

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice.The nurse's most appropriate response would be:

Accepted Answer

Because the liver metabolizes oral contraceptives,their effectiveness is reduced when they are taken simultaneously with anticonvulsants.The statement "Your current medications will reduce the effectiveness of the pill" is true,but it is not the most appropriate response.The anticonvulsant will reduce the effectiveness of the pill,not the other way around.The statement "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 6

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." The nurse's most appropriate response is:

Accepted Answer

The absence of a temperature decrease 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 BBT.

Question 7

In their role of implementing a plan of care for infertile couples,nurses should:

Accepted Answer

Nurses should be open to and ready to help with a variety of medical and nonmedical approaches.

Question 8

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs).The nurse's most appropriate reply is:

Accepted Answer

FAMs are effective with proper vigilance about ovulatory changes in the body and adherence to coitus intervals.They are effective if used correctly by a woman with a regular menstrual cycle.The typical failure rate for all FAMs is 25% during the first year of use.FAMs have no associated health risks.The use of birth control has associated health risks.In addition,taking a pill daily requires compliance on the patient's part.

Question 9

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

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 10

A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her "fertile" time.She asks the nurse about emergency contraception.The nurse tells her that:

Accepted Answer

To minimize the side effect of nausea that occurs with high doses of estrogen and progestin,the woman can take an over-the-counter antiemetic 1 hour before each dose.Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy.Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy.Oral emergency contraceptive regimens may include progestin-only and estrogen-progestin pills.Women with contraindications to estrogen use should use progestin-only pills.

Question 11

A woman will be taking oral contraceptives using a 28-day pack.The nurse should advise this woman to protect against pregnancy by:

Accepted Answer

To maintain adequate hormone levels for contraception and to enhance compliance,patients should take oral contraceptives at the same time each day.If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or abortion,another method of contraception should be used through the first week to prevent the risk of pregnancy.Taken exactly as directed,oral contraceptives prevent ovulation,and pregnancy cannot occur.No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormone levels in oral contraceptive users.If the patient misses two pills during Week 1,she should take two pills a day for 2 days,finish the package,and use a backup method the next 7 consecutive days.

Question 12

Although remarkable developments have occurred in reproductive medicine,assisted reproductive therapies are associated with numerous legal and ethical issues.Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment.Which issue would not need to be addressed by an infertile couple before treatment?

Accepted Answer

Although the method of payment is important,obtaining this information is not the responsibility of the nurse.Many states have mandated some form of insurance to assist couples with coverage for infertility.Risk of multiple gestation is a risk of treatment of which the couple needs to be aware.To minimize the chance of multiple gestation,generally only three or fewer embryos are transferred.The couple should be informed that there may be a need for multifetal reduction.Nurses can provide anticipatory guidance on this matter.Depending on the therapy chosen,there may be a need for donor oocytes,sperm,embryos,or a surrogate mother.Couples who have excess embryos frozen for later transfer 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 13

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

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 14

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

Accepted Answer

The statement "Nonoxynol-9 does not provide protection against sexually transmitted infections,as originally thought; it has also been linked to an increase in the transmission of human immunodeficiency virus and can cause genital lesions" is true.Nonoxynol-9 may cause vaginal irritation,has no effect on the quality of sexual activity,and has no effect on penile sensitivity.

Question 15

Injectable progestins (DMPA,Depo-Provera)are a good contraceptive choice for women who:

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.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 couple comes in for an infertility workup,having attempted to get pregnant for 2 years.The woman,37 years,has always had irregular menstrual cycles but is otherwise healthy.The man has fathered two children from a previous marriage and had 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 sperms.This is unlikely to be the case here because the man has already produced children.Examination for testicular infection would be done before semen analysis.Infection would affect spermatogenesis.

Question 17

A woman has chosen the calendar method of conception control.During the assessment process,it is most important that the nurse:

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 18

A woman is 16 weeks pregnant and has elected to terminate her pregnancy.The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is:

Accepted Answer

The most common technique for medical termination of a pregnancy in the second trimester is D&E.It is usually performed between 13 and 16 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 Pitocin is used to induce labor in a woman with a third-trimester fetal demise.Vacuum aspiration is used for abortions in the first trimester.

Question 19

A woman enquires about herbal alternative methods for improving fertility.Which statement by the nurse is the most appropriate when instructing the patient in 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,golden seal,lavender,juniper,flaxseed,pennyroyal,passionflower,wild cherry,cascara,sage,thyme,and periwinkle.Nettle leaf,dong quai,and vitamin E all promote fertility.Vitamin E,calcium,and magnesium may promote fertility and conception.All supplements and herbs should be purchased from trusted sources.

Question 20

With regard to the assessment of female,male,and couple infertility,nurses should be aware that:

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.

Quiz 5: Infertility, contraception, and Abortion

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.The nurse's most appropriate response is:

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) .The nurse's most appropriate response is:

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,what contraceptive method should she and her partner avoid?