Infertility

23. A Roman Catholic couple is infertile. Their health care practitioner advises them that their best chance of getting pregnant is via in vitro fertilization with a mixture of the man's sperm & donor sperm. Which of the following issues, related to this procedure, should the nurse realize may be in conflict with the couple's religious beliefs? Select all that apply. 1. The man will ejaculate by masturbation into a specially designed condom. 2. The woman may become pregnant with donor sperm. 3. Fertilization is occurring in the artificial environment of the laboratory. 4. More embryos will be created than will be used to inseminate the woman. 5. The woman will receive medications to facilitate the ripening of her ova.

23. CORRECT ANSWER 1, 2, 3, & 4 are the correct choices. Masturbation, as well as the use of a condom, even for the express purpose of creating life, are considered sins in the Catholic tradition. Procreation with the man's sperm alone is unlikely. The addition of the donor sperm makes this unacceptable in the eyes of the Catholic Church since a woman should only become pregnant by her husband. According to the precepts of the Catholic church, fertilization may only take place within the body of the woman. It is immoral, in the Catholic tradition, to create more embryos than are needed to conceive. The medications, alone, would not be contraindicated per the Catholic Church—but only if the ova were being ripened in order for them to become fertilized within her own body. Only then does the church condone the use of the medications.

26. A 35-year-old client is being seen for her yearly gynecological examination. She states that she & her partner have been trying to become pregnant for a little over 6 months, & that a friend had recently advised her partner to take ginseng to improve the potency of his sperm. The woman states that they have decided to take their friend's advice. On which of the following information should the nurse base his or her reply? 1. Based on their history, the client & her partner have made the appropriate decision regarding their fertility. 2. Ginseng can cause permanent chromosomal mutations & should be stopped immediately. 3. It is unnecessary to become concerned about this woman's fertility because she has only tried to become pregnant for a few months. 4. Although ginseng may be helpful, it would be prudent to encourage the woman to seek fertility counseling.

26. CORRECT ANSWER 4. Because fertility drops as a woman ages, it is advisable to encourage the couple to use conventional therapies in conjunction with the complementary therapy to maximize their potential of becoming pregnant. On the web, there are sites that state that ginseng improves the quality & quantity of sperm, although there is no strong evidence to show that that is true. In addition, there is nothing in the question to suggest that the infertility problem is caused by the poor quality of her partner's sperm. There is no evidence that ginseng causes mutations; rather there is some evidence to show that it is antimutagenic. There is cause for concern for this woman since she is 35 years old & has been unable to get pregnant for over 6 months. Complementary therapies are becoming more & more popular among clients. Although many have not been shown to have direct effects, it can be counterproductive to discourage clients from using complementary therapies. This may alienate the clients from the health care provider. Unless they are known to be dangerous, it is much better to encourage clients to combine standard & complementary methods rather than to dissuade clients from using them.

27. A couple is seeking infertility counseling. The practitioner has identified the factors listed below in the woman's health history. Which of these findings may be contributing to the couple's infertility? 1. The client is 36 years old. 2. The client was 13 years old when she started to menstruate. 3. The client works as a dental hygienist 3 days a week. 4. The client jogs 2 miles every day.

27. CORRECT ANSWER 1. The eggs of an older woman (for reproductive purposes considered 35 years +) do age & fertility is reduced. Age 13 at the time of menarche is not a significant factor. . Working as a dental hygienist has not been shown to affect fertility. Excessive exercise can interrupt hormonal function, but jogging 2 miles a day is a moderate exercise pattern. TIP: The woman was 13 years old at menarche, an age that is well within normal limits. Working as a dental hygienist has not been shown to increase one's chances of developing infertility. An excessive exercise schedule is a problem, but jogging 2 miles a day is well within the definition of moderate exercise. When women are over 35 years of age, however, their fertility often drops.

28. A couple who has sought fertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occurs? 1. The testes are overheated. 2. The vas deferens is ligated. 3. The prostate gland is enlarged. 4. The flagella are segmented.

28. CORRECT ANSWER 1. Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm. When the vas deferens is ligated, a man has had a vasectomy & is sterile. The sterility is not, however, due to impaired spermatogenesis, but rather to the inability of the sperm to migrate to the woman's reproductive tract. The prostate does not affect spermatogenesis. An enlarged or hypertrophied prostate is usually a problem that affects older men. The flagella are the "tails" of the sperm. They are normally divided into a middle & an end segment. The suffix "genesis" means "the beginning of, origin of, or the creation of." Therefore, the question is asking which of the factors listed will affect the creation of sperm.

33. A client who is undergoing ovarian stimulation for infertility calls the infertility nurse & states, "My abdomen feels very bloated, my clothes are very tight, & my urine is very dark." Which of the following is the appropriate statement for the nurse to make at this time? 1. "Please take a urine sample to the lab so they can check it for an infection." 2. "Those changes mean that you will menstruate within the next three days." 3. "It is important for you to come into the office to be examined today." 4. "Abdominal bloating is an expected response to the medications."

33. CORRECT ANSWER 3. This client should be seen by her infertility doctor. It is unlikely that this woman has a urinary tract infection. It is unlikely that the client will menstruate soon. Abdominal bloating is a sign of ovarian hyperstimulation. This client is exhibiting signs of ovarian hyperstimulation. This is a serious complication. The client is likely third spacing her fluids (the fluids in her body are shifting into her interstitial spaces), resulting in abdominal distension, oliguria, & concentrated urine. The client should be evaluated by her physician.

36. A couple, who have been attempting to become pregnant for 5 years, is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? Select all that apply. 1. Anger at others who have babies. 2. Feelings of failure because they can't make a baby. 3. Sexual excitement because they want so desperately to conceive a baby. 4. Sadness because of the perceived loss of being a parent. 5. Guilt on the part of one partner because he or she is not able to give the other a baby.

36. CORRECT ANSWER 1, 2, 4, & 5 are correct. Infertility clients often express anger at others who are able to conceive. Infertility clients often express a feeling of personal failure. Sadness is another common feeling expressed by infertility clients. Guilt is commonly expressed by infertility clients. Infertility clients often express an aversion to sex because of the many restrictions/schedules/intrusions that are placed on their sexual relationship. Couples who are experiencing infertility express many emotions. One common thread that connects all of the emotions is grief. Infertile couples grieve their inability to conceive. They experience all of the stages of grief including denial, anger, depression, & bargaining. Acceptance, if it is ever reached, often takes many years.

37. A client is to undergo a postcoital test for infertility. The nurse should include which of the following statements in the client's preprocedure counseling? 1. "You will have the test the day after your menstruation ends." 2. "You will have a dye put into your vein that will show up on x-ray." 3. "You should refrain from having intercourse for the four days immediately prior to the test." 4. "You should experience the same sensations you feel when your doctor does your Pap test."

37. CORRECT ANSWER 4. The client will undergo a speculum examination when cervical mucus will be harvested. The postcoital test is done 1 or 2 days prior to ovulation. No dye is administered & there are no x-ray pictures taken during a postcoital test. The test is performed a few hours after a couple has intercourse. The postcoital test is a simple assessment done to see whether or not the sperm are able to navigate the woman's cervical mucus in order to ascend into the uterus & fallopian tubes. A few hours postcoitus, immediately before ovulation, the practitioner harvests cervical mucus to assess whether or not the sperm are still motile & to assess the ferning patterns of the mucus.

38. A client is to have a hysterosalpingogram. In this procedure, the physician will be able to determine which of the following? 1. Whether or not the ovaries are maturing properly. 2. If the endometrium is fully vascularized. 3. If the cervix is incompetent. 4. Whether or not the fallopian tubes are obstructed.

38. CORRECT ANSWER 4. The primary goal of a hysterosalpingogram is to learn whether or not the fallopian tubes are patent. Only the uterus & the fallopian tubes are evaluated during a hysterosalpingogram. Tumors & other gross assessments of the uterus can be made out, but the vascularization of the endometrium is beyond the scope of the test. The competency of the cervix cannot be evaluated during a hysterosalpingogram. During a hysterosalpingogram, a dye is inserted through the vagina into the uterine cavity. The dye, visualized on x-ray, then travels up into the fallopian tubes. If the tubes are blocked owing to scarring or endometriosis, the dye does not ascend.

16. A nurse is teaching an infertile couple about how the sperm travel through the man's body during ejaculation. Please put the following five major structures in order, beginning with the place where spermatogenesis occurs & continuing through the path that the sperm & semen travel until ejaculation. 1. Epididymis. 2. Prostate. 3. Testes. 4. Urethra. 5. Vas deferens.

16. CORRECT ANSWER 3, 1, 5, 2, 4. The sperm are produced in the testes (3). They then proceed to the epididymis (1) where they mature. The vas deferens (5) is the conduit through which the sperm first travel during ejaculation. The prostate (2), encircling the neck of the urethra, produces a fluid that protects the sperm, and, finally, the sperm exit the male body via the urethra (4). Although maternity is often viewed as a topic in women's health, it must be remembered that the male's contribution to the embryo is as important to a healthy pregnancy outcome as the woman's. Understanding the male reproductive system is, therefore, a necessary requirement.

17. A client has been notified that endometriosis is covering her fimbriae. She asks the nurse why that is such a problem. The nurse advises the woman that fertilization is often impossible when the fimbriated ends are blocked. Please place an "X" on the diagram to show the woman where fertilization takes place.

17. CORRECT ANSWER The student should place an "X" on the outer third of the fallopian tube. The question is actually asking where fertilization takes place—which is in the outer third of the tube.

22. An infertile woman has been diagnosed with endometriosis. She asks the nurse why that diagnosis has made her infertile. Which of the following explanations is appropriate for the nurse to make? 1. "Scarring surrounds the ends of your tubes preventing your eggs from being fertilized by your partner's sperm." 2. "You are producing insufficient quantities of follicle-stimulating hormone that is needed to mature an egg every month." 3. "Inside your uterus is a benign tumor that makes it impossible for the fertilized egg to implant." 4. "You have a chronic infection of the vaginal tract that makes the secretions hostile to your partner's sperm."

22. CORRECT ANSWER 1. Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The tissue may be on, for example, the tubes, ovaries, or colon. Adhesions develop from the monthly bleeding at the site of the misplaced endometrial tissue, often resulting in infertility. Endometriosis is not characterized by hormonal imbalances. Hormonal imbalances can, however, lead to infertility. A benign tumor of the muscle of the uterus is called a fibroid. It can interfere with pregnancy, but it is not related to endometriosis. Endometriosis is not caused by an infection.

24. Infertility increases a client's risk of which of the following diseases? 1. Diabetes mellitus. 2. Nystagmus. 3. Cholecystitis. 4. Ovarian cancer.

24. CORRECT ANSWER 4. Infertility has been shown to increase a woman's risk of developing ovarian cancer. Diabetes has been shown to affect a woman's fertility, but infertility has not been shown to increase a woman's risk of developing diabetes. Infertility has not been shown to increase a woman's risk of developing nystagmus. Infertility has not been shown to increase a woman's risk of developing cholecystitis. For a number of years, an association was noted between the use of Clomid (clomiphene) to treat infertility & the incidence of ovarian cancer. It has also been shown that the infertility itself is a contributing factor for ovarian cancer. The reason for the association is not yet known. (See http://www.cancer. org/docroot/CRI/content/CRI_2_2_2X_ What_causes_ovarian_cancer_Can_it_be_ prevented_33.asp?sitearea=CRI)

25. A client is to receive Pergonal (menotropins) injections for infertility prior to in vitro fertilization. Which of the following is the expected action of this medication? 1. Prolongation of the luteal phase. 2. Stimulation of ovulation. 3. Suppression of menstruation. 4. Promotion of cervical mucus production.

25. CORRECT ANSWER 2. Pergonal is administered to infertile women to increase follicular growth & maturation of the follicles & to Stimulate ovulation. The luteal phase occurs after ovulation. Pergonal is given to induce ovulation. Pergonal does not suppress menstruation or promote cervical mucus production. Pergonal does not suppress menstruation or promote cervical mucus production. Know the action of Pergonal. A "tropin" is a substance that stimulates an organ to do something. The only answer that states that an organ is being stimulated is answer 2.

30. An infertile man is being treated with Viagra (sildenafil citrate) for erectile dysfunction (ED). Which of the following is a contraindication for this medication? 1. Preexisting diagnosis of herpes simplex 2. 3. Retinal damage from type I diabetes mellitus. 2. Nitroglycerin ingestion for angina pectoris. 4. Postsurgical care for resection of the prostate.

30. CORRECT ANSWER 2. It is unsafe to take Viagra while also taking nitroglycerin for angina. A diagnosis of herpes simplex 2 is not a contraindication for taking Viagra. Viagra is often prescribed for clients with erectile dysfunction (ED) from diabetes mellitus. Viagra is often prescribed for clients with ED from prostate resection. Viagra has been shown to increase the hypotensive effects of nitrate-containing medications. It should not be taken in conjunction with any medication that contains nitrates, including nitroglycerin..

35. An infertility specialist is evaluating whether a woman's cervical mucus contains enough estrogen to support sperm motility. Which of the following tests is the physician conducting? 1. Ferning capacity. 2. Basal body temperature. 3. Culposcopy. 4. Hysterotomy.

35. CORRECT ANSWER 1. When a woman's cervical mucus is estrogen rich, it is slippery & elastic (thread-like), & when assessed under a microscope, the practitioner will observe "ferning,"—that is, an image that looks like a fern. The woman is then in her fertile period. When she is not in her fertile period, the mucus is thick & gluey. Basal body temperature assessments are performed to determine if & when ovulation occurs. Culposcopy is a procedure performed to examine the cervix closely. It is not performed to evaluate the receptivity of a woman's cervical mucus to sperm. A hysterotomy is a procedure in which an incision is made into the uterus. When estrogen levels are high, a woman's cervical mucus is most receptive to a man's sperm. At that time, the pH of the vaginal & cervical environments is most conducive to the sperm's successful migration into the uterus & into the fallopian tubes.

19. A couple is seeking advice regarding actions that they can take to increase their potential of becoming pregnant. Which of the following recommendations should the nurse give to the couple? 1. The couple should use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The man should be on top during intercourse.

19. CORRECT ANSWER 3. The woman should refrain from douching. Douching can change the normal flora & the pH in the vagina, making the environment hostile to the sperm. Use of vaginal lubricants is not recommended. Vaginal lubricants may alter the pH of the reproductive system, adversely affecting the couple's potential of becoming pregnant. Delaying intercourse until the day of ovulation is a poor recommendation. The sperm live for about 3 days. If the couple has daily intercourse beginning 5 or 6 days before ovulation & continuing until the day of ovulation, they will maximize their potential of becoming pregnant. (See Wilcox AJ, et al. Timing of sexual intercourse in relation to ovulation. N Engl J Med 1995; 333:1517-21.) The position of the couple during intercourse will not affect the potential fertility of the woman. There is a great deal of false information in the community regarding ways to maximize one's ability to become pregnant. For example, some couples believe that they should have intercourse less frequently when trying to become pregnant because sperm potency drops with frequent ejaculations. This fact has not been shown to be true. Clients need fact-based information regarding ways to maximize their ability to conceive.

29. A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? 1. The couple has established a set schedule for their sexual encounters. 2. The couple has been married for more than eight years. 3. The couple lives with one set of parents. 4. The couple has close friends who gave birth to a baby within the last year.

29. CORRECT ANSWER 1. Clients who "schedule" intercourse often complain that their sexual relationship is unsatisfying. Years of marriage are not directly related to a couple's sexual relationship. Clients may have a very healthy relationship after many years of marriage. The fact that the couple lives with one set of parents is unlikely related to their sexual relationship. Although it can be very difficult to be around couples who have become pregnant and/or have healthy babies, this factor is not usually related to a couple's sexual relationship. When the nurse identifies sexual dysfunction related to decreased libido as a diagnosis, then the assessments, as well as the goals, interventions, & evaluations, must relate directly to that problem.

31. A client has been notified that because of fallopian tube obstruction, her best option for becoming pregnant is through in vitro fertilization. The client asks the nurse about the procedure. Which of the following responses is correct? 1. "During the stimulation phase of the procedure, the physician will make sure that only one egg reaches maturation." 2. "Preimplantation genetic diagnosis will be performed on your partner's sperm to make sure that the sperm are normal." 3. "After ovarian stimulation, you will be artificially inseminated with your partner's sperm." 4. "Any extra embryos will be preserved for you if you wish to conceive again in the future."

31. CORRECT ANSWER 4. Since multiple embryos are usually created during the in vitro process, there are often more embryos created than are implanted. The couple may preserve the embryos. Physicians usually want a number of eggs to reach maturation. Preimplantation genetic assessment, when done, is performed on the fertilized ova, not on the sperm or unfertilized ova. Artificial insemination will not be performed because the client's tubes are blocked. The preserved embryos may be implanted in the future. For example, if the first transfer fails to result in a pregnancy, the remaining embryos may be transferred within a few months. If a pregnancy & a delivery do result, the couple may choose to implant the remaining embryos in the future when they choose to have another child.

39. A client's basal body temperature chart for one full month is shown below. Based on the temperatures shown, what can the nurse conclude? 1. It is likely that the client has not ovulated. 2. The client's fertile period is between 12 & 18 days. 3. The client's period is abnormally long. 4. It is likely that her progesterone levels rose on day 15.

39. CORRECT ANSWER 1. When no temperature shifts are noted, it is likely that the client has not ovulated. If the client is not ovulating, she has no fertile period. A 7-day menstrual period is not abnormally long. There is no evidence of a progesterone elevation. Be able to make basic interpretations of BBT charts. There is usually a slight dip in the temperature at the LH surge with a rise in temperature for the remainder of the cycle because of the thermogenic effect of progesterone. When no temperature changes are seen, it is likely that the client is not experiencing normal hormonal changes & is not ovulating.

41. A couple has been told that the male partner, who is healthy, is producing no sperm "because he has cystic fibrosis." Which of the following explanations is accurate in relation to this statement? 1. Since the man is healthy he could not possibly have cystic fibrosis. 2. Men with cystic fibrosis often have no epididymis. 3. The expressivity of cystic fibrosis is variable. 4. Cystic fibrosis is a respiratory illness having nothing to do with reproduction

41. CORRECT ANSWER 3. This statement is correct. Cystic fibrosis can be expressed in a number of ways. Some affected individuals have very serious illness resulting in early death, while others experience few symptoms. The man may have both recessive genes for cystic fibrosis even though he is not ill. This answer is incorrect. Some men with cystic fibrosis, however, have no vas deferens. This statement is incorrect. Some males with cystic fibrosis have no vas deferens and, even if the vas is present, if the man is producing large amounts of thick mucus, the vas may become obstructed. Similarly, in women, the fallopian tubes may become obstructed with thick mucus. Infertility & genetics are often related. In this situation, the genetic disease cystic fibrosis has resulted in aspermia. In addition, many miscarriages are caused by inborn genetic defects. In general, clients who are infertile should be referred for genetic counseling.

42. A female client seeks care at an infertility clinic. Which of the following tests may the client undergo to determine what, if any, infertility problem she may have? Select all that apply. 1. Chorionic villus sampling. 2. Endometrial biopsy. 3. Hysterosalpingogram. 4. Serum progesterone assay. 5. Postcoital test.

42. CORRECT ANSWER 2, 3, 4, & 5 are correct. Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. Hystero-salpingogram is performed after menstruation to detect whether or not the fallopian tubes are patent. Serum progesterone assay is performed about 1 week following ovulation to determine whether or not the woman's corpus luteum produces enough progesterone to sustain a pregnancy. Postcoital tests are performed about 1-2 days before ovulation to determine whether or not healthy sperm are able to survive in the cervical mucus. Chorionic villus sampling is done to assess for genetic disease in the fetus. There are a number of tests that are performed to assess fertility in couples. It is important to remember that many of the assessments are invasive, painful, embarrassing, and, depending on the results, may label one of the partners as the cause of the infertility. The knowledge of who is responsible for the infertility can be very difficult for some clients to learn.

44. A client is receiving Pergonal (menotropins) intramuscularly for ovarian stimulation. Which of the following is a common side effect of this therapy? 1. Piercing rectal pain. 2. Mood swings. 3. Visual disturbances. 4. Jerky tremors.

44. CORRECT ANSWER 2. Mood swings & depression are common side effects of the hormonal therapy. Piercing rectal pain has not been cited as a side effect of Pergonal. Visual disturbances have not been cited as a side effect of Pergonal. Jerky tremors have not been cited as a side effect of Pergonal. Not only is infertility itself a psychological stressor but the therapy used to treat it is also a stressor. The client is given daily injections of Pergonal (a mixture of FSH & LH) for 10 days to 2 weeks. The impact of the hormonal injections can be very disruptive to the woman's psyche, leading to mood swings and, in some cases, severe depression.

20. A nurse working in an infertility clinic should include which of the following in her discussions with the couple? 1. Adoption as an alternative to infertility treatments. 2. The legal controversy surrounding artificial insemination. 3. The need to seek marriage counseling before undergoing infertility treatments. 4. Statistics regarding the number of couples who never learn why they are infertile.

20. CORRECT ANSWER 1. It is important for the couple to be provided with all relevant information. Adoption is a viable alternative to infertility treatments. Although there are moral/ethical issues surrounding artificial insemination, there are no legal controversies. Artificial insemination is a legal procedure. Although it is not without merit, marriage counseling is not mandatory before seeking infertility treatments. Although some causes of infertility may not be discovered, in the majority of cases a cause is found: 1/3 of cases related to female problems, 1/3 of cases related to male problems, & 1/3 of cases a combination of male & female problems. Whenever clients seek assistance from health care professionals, it is the obligation of the professional to provide the clients with all options of care. In the case of infertility, clients should be advised regarding infertility counseling, testing, & interventions as well as adoption strategies. The couple should determine, for themselves, which route(s) they wish to pursue.

32. A client asks the nurse about the gamete intrafallopian transfer (GIFT) procedure. Which of the following responses would be appropriate for the nurse to make? 1. Fertilization takes place in the woman's body. 2. Zygotes are placed in the fallopian tubes. 3. Donor sperm are placed in a medium with donor eggs. 4. A surrogate carries the infertile woman's fetus.

32. CORRECT ANSWER 1. This statement is true. Although the gametes are placed in the fallopian tubes artificially, fertilization does occur within the woman's body. Number 2 is true of zygote intrafallopian transfer (ZIFT), not of gamete intrafallopian transfer (GIFT). Although donor eggs & sperm can be used, usually the couple's own gametes are used. When they are harvested, the gametes are placed directly into the woman's fallopian tubes. Number 4 describes surrogacy. A surrogate is usually impregnated via artificial insemination.

40. Which instruction by the nurse should be included in the teaching plan for an infertile woman who has been shown to have a 28-day biphasic menstrual cycle? 1. Douche with a cider vinegar solution immediately before having intercourse. 2. Schedule intercourse every day from day 8 to day 14 of the menstrual cycle. 3. Be placed on follicle-stimulating hormone therapy by the fertility specialist. 4. Assess the basal body temperature pattern for at least 6 more months.

40. CORRECT ANSWER 2. This action is recommended. Pregnancy is most likely to occur with daily intercourse from 6 days before ovulation up to the day of ovulation. Unless medically indicated, douching should never be performed. A vinegar solution is especially inappropriate since sperm are unable to survive in an acidic environment. If a client is experiencing a biphasic cycle, FSH therapy is probably not indicated. The BBT chart need not be monitored for 6 more months, although it can be used to help time intercourse. A biphasic cycle on a BBT chart is evidenced by a relatively stable temperature at the beginning of the cycle, a slight dip in temperature at the time of ovulation, & a sustained rise in temperature—of at least 0.4°F for the remainder of the cycle.

45. A client is to have a hysterosalpingogram. Which of the following information should the nurse provide the client prior to the procedure? 1. "The test will be performed through a small incision next to your belly button." 2. "You will be on bed rest for a full day following the procedure." 3. "An antibiotic fluid will be instilled through a tube in your cervix." 4. "You will be asked to move from side to side so that x-ray pictures can be taken."

45. CORRECT ANSWER 4. This statement is correct. A number of pictures will be taken throughout the procedure. The client, who will be awake, is asked to move into positions for the x-rays. No incision is created when clients have hysterosalpingograms. The client will be able to ambulate normally after the procedure. A dye is instilled into the uterine cavity. Some doctors do prescribe oral antibiotics following the procedure to prevent infection. A hysterosalpingogram is one of the many tests performed during a standard infertility work-up. The test taker should be familiar with the rationale for each of the tests as well as the procedures themselves & the information that should be conveyed to each client who is to undergo one of the procedures.

18. The nurse is providing counseling to a group of sexually active single women. Most of the women have expressed a desire to have children in the future, but not within the next few years. Which of the following actions should the nurse suggest the women take to protect their fertility for the future? Select all that apply. 1. Use condoms during intercourse. 2. Refrain from smoking cigarettes. 3. Maintain an appropriate weight for height. 4. Exercise in moderation. 5. Refrain from drinking carbonated beverages.

18. CORRECT ANSWER 1, 2, 3, 4 are the correct choices. Condoms should be worn during sexual contacts to prevent becoming infected with a sexually transmitted disease, which can impact the long-term health of the woman's reproductive system. Women who smoke have a higher incidence of infertility than those who do not smoke. (See http://www.asrm. org/Patients/FactSheets/smoking.pdf) Women who are either overweight or underweight have increased incidence of infertility. Body mass index (BMI) is related to the amount of exercise a woman engages in. Those who exercise excessively are more likely to have a very low BMI & those who rarely exercise to be obese. Since fertility is related to body weight, it is recommended that women exercise in moderation. There is some evidence that caffeine in large quantities may affect fertility, but decaffeinated carbonated beverages have never been cited as impacting one's fertility. There are a number of factors that can affect fertility. Some of the factors are beyond a woman's control. For example, a woman may not marry until she is in her 30s and, consequently, may delay conception. Other factors, such as smoking cigarettes & exercising, are controllable.

21. An Orthodox Jewish couple is seeking infertility counseling. The woman states that her menstrual cycle is 21 days long. After testing, no physical explanation is found for the infertility. Which of the following may explain why the woman has been unable to conceive? 1. Her Kosher diet is lacking in the essential nutrients needed for achieving optimal reproductive health. 2. The positions allowed Orthodox Jewish couples during intercourse hinder the process of fertilization. 3. Orthodox Jewish couples are known to have a high rate of infertility because of inborn genetic diseases. 4. Orthodox Jewish couples refrain from intercourse during menses & for seven days after it ends.

21. CORRECT ANSWER 4. Jewish law does prohibit intercourse during the menses & for 7 days following menses. The woman then goes through a cleansing bath called a mikvah before she & her husband may have intercourse. With such a short cycle, she is ovulating during the time frame in which intercourse is restricted. Kosher diets are complete, providing all nutrients, vitamins, minerals, etc. needed by the body. There are no specific positions, mandated by Jewish law, that inhibit fertilization. Although Jews do exhibit a large number of genetic diseases, they are not prone to infertility in higher numbers than the general population. Remember to consider cultural differences when making nursing assessments & considering nursing interventions. There are three main Jewish traditions: Orthodox, Conservatism, & Reform. Orthodox Jews strictly adhere to the Laws set forth in the Torah, the first 5 books of the Bible. Conservative Jews are observant but less restrictive in their beliefs, while Reform Jews are the most liberal in their traditions. When asked about Jewish traditions, it is important for the test taker to be aware of which group of Jews is being discussed.

34. Nurses working in a midwifery office have attended a conference to learn about factors that increase a woman's risk of becoming infertile. To evaluate the nurses' learning, the conference coordinator tested the nurses' knowledge at the conclusion of the seminar. Which of the following problems should the nurses state increase a client's risk of developing infertility problems? Select all that apply. 1. Women who have menstrual cycles that are up to 30 days long. 2. Women who experience pain during intercourse. 3. Women who have had pelvic inflammatory disease. 4. Women who have excess facial hair. 5. Women who have menstrual periods that are over 5 days long

34. CORRECT ANSWER 2, 3, & 4 are correct. Dyspareunia, or pain during intercourse, may be a symptom of a sexually transmitted infection (STI) or of endometriosis. Both STIs & endometriosis can adversely affect a woman's fertility. A woman who has had PID is much more likely to have blocked fallopian tubes than a woman who has never had PID. Women who have facial hair (hirsutism) often have polycystic ovarian syndrome (PCO). PCO patients are usually obese & have irregular menses. Women with PCO are very often infertile. A 30-day menstrual cycle is well within normal limits. A 5-day menstrual period is well within normal limits. Women with PCO have many symptoms: hirsutism, obesity, insulin resistance, & infertility, to name a few. To improve the chances of a woman with PCO becoming pregnant, she is usually prescribed Clomid (clomiphene) for the infertility & Glucophage (metformin) for the insulin resistance. Sexually transmitted infections may also impair a woman's fertility.

43. A client is hospitalized in the acute phase of severe ovarian hyperstimulation syndrome. The following nursing diagnosis has been identified: Fluid volume excess (extravascular) related to third spacing. Which of the following nursing goals is highest priority in relation to this diagnosis? 1. Client's weight will be within normal limits by date of discharge. 2. Client's skin will show no evidence of breakdown throughout hospitalization. 3. Client's electrolyte levels will be within normal limits within one day. 4. Client's lung fields will remain clear throughout hospitalization.

43. CORRECT ANSWER 4. This is the priority nursing goal related to ovarian hyperstimulation syndrome. The others are important goals, but they are not the priority nursing goals. A client who is suffering from ovarian hyperstimulation syndrome experiences intravascular hypovolemia, & a related extravascular hypervolemia. Although the exact cause of the shift in fluids is unknown, the client may experience very serious complications, including pulmonary edema & ascites. The client is hospitalized & palliative therapy is provided until the client's fluid & electrolytes stabilize. It is essential throughout the client's acute phase to make sure that her pulmonary function remains intact.