Maternal & Child Health Nursing Chapter 7
Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?
12 months Infertility is the failure to achieve conception after 1 year of unprotected intercourse.
A client is to take clomiphene citrate for infertility. Which outcome should the nurse explain is the expected action of this medication? A) Stimulate the release of ova B) Decrease testosterone levels C) Reduce inflamed endometrium D) Break down scar tissue
A) Stimulate the release of ova Clomiphene citrate stimulates the release of FSH and LH which is responsible for the maturity and release of ovum from the ovary.
A client is being prepared for artificial insemination. Which finding is the most suggestive to determine if the client is ovulating? A) fall in body temperature B) abdominal cramps C) change in the cervical mucus D) slight weight gain
C) change in the cervical mucus Change in the appearance and consistency of cervical mucus is an indication of ovulation. Slight weight gain and abdominal cramps are not signs used to determine ovulation. At the time of ovulation, body temperature is slightly elevated.
A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success? A) "If you have been trying for this long without success, something must be wrong. So we will need to run a series of tests to see what that is." B) "Weight has no bearing on the ability to conceive. Something else must be going on with your reproductive organs." C) "Being this overweight is unhealthy for you and for any child that you may bring into the world. Before you consider conceiving, you should lose weight." D) "Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering."
D) "Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." Extreme obesity in a male may interfere with effective penetration and deposition of sperm, compromising the ability to conceive.
A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply. A) semen analysis B) fertility drugs C) tubal patency D) in vitro fertilization counseling E) ovulation monitoring
A) semen analysis C) tubal patency E) ovulation monitoring Today, a subfertility investigation usually is limited to three assessments: semen analysis, ovulation monitoring, and tubal patency.
A couple comes to the clinic stating that they have one child who is 4 years old, but they have been trying to have another child for 1 year without success. What type of subfertility would this be considered? A) Sterility B) Secondary subfertility C) Erectile dysfunction D) Primary subfertility
B) Secondary subfertility In secondary infertility, there has been a previous viable pregnancy, but the couple cannot conceive at present.
A couple comes in and tells the nurse that they have been trying diligently to conceive for the last 3 months and are subfertile. What should the nurse explain to the couple about the definition of subfertility? A) Subfertility is said to exist when a pregnancy has not occurred after at least 2 years of engaging in unprotected coitus. B) Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus. C) Subfertility is said to exist when a pregnancy has not occurred after at least 6 months of engaging in unprotected coitus. D) Subfertility is said to exist when a pregnancy has not occurred after at least 3 months of engaging in unprotected coitus.
B) Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus. Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus.
A 32-year-old man comes to the clinic for a refill of his antihypertensive medication tenormin (Atenolol). He tells the nurse that since he has been taking the medication, he cannot sustain an erection. What type of erectile dysfunction is this patient experiencing? A) Stress erectile dysfunction B) Primary erectile dysfunction C) Premature ejaculation D) Secondary erectile dysfunction
D) Secondary erectile dysfunction The condition is secondary erectile dysfunction, because the man has been able to achieve erections in the past but now has difficulty.
Which outcome would be most appropriate for the nurse to establish for a client who has a myomectomy with an intrauterine device placed? A) The client will experience decrease blood loss B) The client will wait 1 year to attempt conception C) The client will begin oral contraceptives D) The client will have the IUD removed in 1 month
D) The client will have the IUD removed in 1 month The purpose of the IUD placement is to prevent uterine sides from touching and forming adhesions. In 1 month, the IUD can be removed. The nurse will need to provide a good explanation of the purpose of the IUD with the client stating understanding of it.
A male patient comes to the clinic and informs the primary care provider that he and his wife are trying unsuccessfully to conceive. He adds that he cannot get an erection and believes this problem started when he began taking blood pressure medicine. What type of erectile dysfunction would be suspected? A) tertiary erectile dysfunction B) sterility C) primary erectile dysfunction D) secondary erectile dysfunction
D) secondary erectile dysfunction Erectile dysfunction after previously being able to achieve ejaculation is referred to as secondary erectile dysfunction. Primary erectile dysfunction is when a man has never been able to achieve an erection. There is no tertiary erectile dysfunction. Sterility refers to an inability to conceive.
The nurse is assessing a male client who is concerned about his ability to produce enough sperm to have a child. He tells the nurse, "I have had some issues in my younger years." What questions would be important for the nurse to ask this client? Select all that apply. A) "Are you exposed to X-rays or other radioactive substances?" B) "When was the last time you had sex?" C) "Do you have a regular girlfriend?" D) "Do you use drugs or use alcohol excessively? E) "Have you ever had any type of trauma or surgery on or near your testicles?"
A) "Are you exposed to X-rays or other radioactive substances?" D) "Do you use drugs or use alcohol excessively?" E) "Have you ever had any type of trauma or surgery on or near your testicles?" Conditions that may inhibit sperm production are trauma to the testes, surgery on or near the testicles that results in impaired testicular circulation, and endocrine imbalances, particular of the thyroid, pancreas, or pituitary glands. Drug use or excessive alcohol use and environmental factors such as exposure to X-rays or radioactive substances have also been found to negatively affect spermatogenesis. Men exposed to radioactive substances in their work environments should be provided adequate protection for the testes.
A female client who comes to the clinic for a visit is diagnosed with Turner's syndrome. The nurse would expect the client to experience which of the following? A) Compromised or absent fertility B) Maternal tubal problems C) Development of cystic fibrosis in male offspring D) Development of respiratory distress syndrome in her infant
A) Compromised or absent fertility A client with Turner's syndrome, a genetic condition in which one of the two sex chromosomes is completely or partially absent, will have a compromised or absent fertility. Cystic fibrosis in males is a genetic condition, but the male child will not develop cystic fibrosis due to client's Turner's syndrome. The client's child is not susceptible to respiratory distress syndrome due to the client's genetic disorder. Preterm babies are at increased risk for respiratory distress syndrome. Turner's syndrome will not cause tubal problems in the client. Tubal problems are caused due to ascending pelvic infections, inflammation from intrauterine device, surgical adhesions or previous ectopic pregnancy.
The nurse is caring for a couple who are trying to get pregnant and have not been able to for over a year. The nurse explains to the couple that diagnostic testing usually begins on the male partner, as these tests are easier. The couple asks what kind of problems a man can have that can cause infertility. What should be the nurse's response? A) "Men can have increased prolactin levels that decrease sperm viability." B) "Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen." C) "Men may not have enough estrogen and FSH in their bodies to maintain testicular function." D) "Men may ejaculate into the bladder instead of the vagina."
B) "Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen." Men may be affected by varicoceles, varicose veins around the testicle, which decrease semen quality by increasing testicular temperature. Retrograde ejaculation or ejaculation into the bladder is assessed by urinalysis after ejaculation. Blood tests for male partners may include measuring testosterone; FSH and LH (both of which are involved in maintaining testicular function); and prolactin levels. Therefore options A, C, and D are incorrect.
A 25 year old having a yearly check-up informs the nurse that she has stopped taking birth control pills because she and her husband want to start a family. She states, "I know I will get pregnant right away, because my mother was very fertile." What is the nurse's best response? A) "Based on your history, you probably won't experience a problem getting pregnant." B) "Women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them." C) "It seems that everybody is different when it comes to getting pregnant." D) "The chance of subfertility increases with age, especially after the age of 20."
B) "Women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them." Although the chance of subfertility increases with age, this patient is 25 years old, so that issue does not apply. The nurse should inform her that after stopping birth control pills it may take several months for the body to restore normal functioning, so it may take time to conceive. The other statements are not appropriate. Although each person is an individual, the statement about everybody being different offers false reassurance and does not address the client described in the scenario.
A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client? A) the scrotum B) the vas deferens C) the ejaculatory ducts D) the epididymis
B) the vas deferens The two vas deferens or ductus deferentia are ligated and cut in the male sterilization procedure, called a vasectomy. The epididymis serves as a site for sperm to mature and be stored until ejaculation occurs. The ejaculatory ducts empty into the urethra and receive secretions from the prostate gland to make up semen. The scrotum is a sac-like structure that sits behind the penis and houses the testicles.
A 36-year-old male client whose wife has been unable to conceive is referred for semen analysis. The client prefers to collect the specimen at home. Which instruction should the nurse provide about collecting and transporting the specimen? A) Have intercourse before collecting the semen B) Collect the specimen in an lubricated condom C) Carry the semen specimen in an inner pocket D) Place the specimen in the refrigerator before taking it to the laboratory
C) Carry the semen specimen in an inner pocket It is acceptable for the man to collect the specimen at home or in another private setting and to deliver it to the laboratory within a specified period. When the specimen requires transport to the laboratory, the nurse should instruct the client to carry the specimen in an inner pocket so that it remains at body temperature until it can be analyzed. Placing the specimen in the refrigerator would be inappropriate. A complete semen analysis is performed on a specimen collected after 2 to 3 days of abstinence from intercourse. Therefore, the client should not have intercourse before collecting the semen sample. Men who cannot produce a specimen by masturbating or who have personal reservations can collect it in an unlubricated condom that does not contain spermicides.
A couple comes to the clinic and informs the nurse that they have been trying to conceive for 6 months with no success. The husband states that they have coitus at least 5 or 6 times per week to optimize their chance of success. What can the nurse educate the couple about frequency of coitus? A) The couple should have coitus only when the female partner is ovulating. B) The male partner should check his sperm count each time he has coitus to ensure an adequate count. C) The couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count. D) The couple should continue to have unprotected coitus daily to improve the chance of conception.
C) The couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count. Couples who engage in coitus daily, hoping to cause impregnation, may actually have more difficulty conceiving than those who space coitus to every other day. This is because too frequent coitus can lower a man's sperm count to a level below optimal fertility.
A male client visits a fertility clinic after one year of attempting unsuccessfully to impregnate his wife. What is a risk factor associated with male infertility? A) sperm density about 20 million/mL B) 2 to 5 mL of semen ejaculated C) no or few sperm cells produced D) morphology of sperm within normal limits
C) no or few sperm cells produced Azospermia or oligospermia (no or few sperm cells produced) is a risk factor affecting male infertility. Normally, the volume of semen ejaculated needs to be about 2-5 mL, with a density of sperm at about 20 million/mL. In addition to the number of sperm, the motility (movement), viability, and morphology (shape) of the sperm must be within normal limits.
A pregnant client has been diagnosed as having a urinary tract infection (UTI). Which of the following instructions regarding control of the infection should the nurse provide the client? A) Restrict the intake of salt in the diet B) Clean from back to front after urination C) Abstain from sexual intercourse D) Wear cotton underwear
D) Wear cotton underwear The nurse should instruct the pregnant client with a urinary tract infection to avoid irritation of the perineal area by wearing cotton underwear instead of synthetic ones. Abstinence from sexual activity is not needed in such a case. The client should be advised to wipe from front to back after sexual intercourse and urination. For good perineal hygiene, the nurse should instruct the client to clean her perineum in a front-to-back direction, and not from a back-to-front direction. Restriction of salt intake may be necessary for the treatment of hypertension, but not urinary tract infection.
A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? A) serologic test for syphilis, semen analysis, and tubal patency assessment B) semen analysis, urinalysis, and ovulation monitoring C) pelvic sonogram, ovulation monitoring, and semen analysis D) semen analysis, ovulation monitoring, and tubal patency assessment
D) semen analysis, ovulation monitoring, and tubal patency assessment Only three tests are commonly used to test fertility: semen analysis in the male and ovulation monitoring and tubal patency assessment in the female. Additional testing may be performed both on the man and the woman, which may include urinalysis, serologic test for syphilis, and pelvic sonogram, but these are not the primary tests used.
