OB Chapter 5: Infertility, Contraception, and Abortion

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse tells him to: 1 ejaculate into a sterile container. 2 obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days. 3 transport specimen with container packed in ice. 4 ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

2 obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days. An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.

What is the significance of the clomiphene citrate challenge test (CCCT)? To assess: 1 If the fallopian tubes are open and patent 2 for the presence of uterine abnormalities 3 The amount of progesterone production 4 Follicle-stimulating hormone (FSH) levels

4 Follicle-stimulating hormone (FSH) levels The clomiphene citrate challenge test (CCCT) is used to assess follicle-stimulating hormone (FSH) levels. In this test, 100 mg of clomiphene (Clomid) is administered to the patient from day 3 to day 10 of the menstrual cycle. Follicle-stimulating hormone (FSH) levels are assessed on the 3rd day and the 10th day after clomiphene (Clomid) is administered. FSH levels greater than 20 indicate that the pregnancy will not occur with the woman's own eggs. FSH levels less than 15 suggest an adequate ovarian reserve in the patient. Patency in the fallopian tubes is assessed by hysterosalpingogram, hysterosalpingo-contrast sonography, and chlamydia immunoglobulin G antibodies. Uterine abnormalities are assessed by hysterosalpingogram and hysterosalpingo-contrast sonography. Progesterone production is assessed by the serum progesterone test.

Which symptom in a woman who is using oral contraceptives should be reported to the physician immediately? 1. 5-lb weight gain in a month 2 Leg pain and edema 3 Decrease in menstrual flow 4 Increased pigmentation of the face

2 Leg pain and edema Oral contraceptives increase clotting factors that may place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain in the first month is a common finding. A decrease in menstrual flow is an expected finding. An increased pigmentation of the face is a common finding.

The nurse is counseling a patient who has had multiple miscarriages. The nurse explains to the patient that she has developed endometriosis. In which category would this be placed as a cause of infertility? 1 Tubal factors 2 Ovarian factors 3 Uterine factors 4 Cervical factors

1 Tubal factors A series of steps are required for successful conception. Interference in any one of the steps may result in infertility. Tubal factors would be the cause of this patient's infertility. The fertilized embryo was unable to reach the uterus by passing through the fallopian tubes because of the patient's endometriosis. Ovarian factors that cause infertility impair the process of production of healthy oocytes during the menstruation cycle. A successfully formed fertilized embryo signifies that oocytes are healthy. This patient does not have uterine factors that cause infertility since the patient is able to successfully conceive. The uterine factors may affect the process of implantation and nourishment of the embryo in the uterus. The fertilized egg is unable to reach the uterus. Any change in the anatomy of the cervix that affects the movement of the sperm into the uterus indicates a cervical factor. In this patient, the embryo was fertilized. This indicates that the sperm were able to pass through the uterus and fertilize the egg. Therefore it is not a cervical factor.

A patient is administered progestins (Depo-Provera) through the intramuscular route. What should the nurse suggest to the patient to prevent complications? The patient should increase: 1 Iron intake. 2 Calcium intake. 3 Protein intake. 4 Potassium intake.

2 Calcioum intake Patients who take progestins such as depot medroxyprogesterone acetate (Depo-Provera) may lose significant bone mineral density, which may cause osteoporosis in time. Therefore, the nurse should recommend increasing the daily calcium intake for patients who are on progestins. Iron intake is encouraged in the patients who are anemic; progestins do not cause anemia. Progestins do not affect the protein and potassium levels in the body. Therefore, the nurse need not suggest that the patient eat a diet rich in protein or potassium.

Which response by the nurse is most appropriate when a woman asks, "What contraceptive do you think I should use?" 1 "Your health care provider will know what is best for you." 2 "The male condom is probably the easiest for you to use." 3 "Because you are younger than 40, you should use oral contraceptives." 4 "I can discuss the various methods so you can decide what is best for you."

4 "I can discuss the various methods so you can decide what is best for you." The nurse should provide the woman with all the necessary information to make an informed decision, but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.

After checking the laboratory report of a patient, the nurse reports to the primary health care provider findings that the patient has developed insulin resistance and anovulation. What should the nurse expect to be prescribed for the patient? 1 Danazol (Danocrine) and glipizide (Glucotrol) 2 Bromocriptine (Parlodel) and glyburide (Diabeta) 3 Progesterone (Prometrium) and acarbose (Precose) 4 Clomiphene (Clomid) and metformin (Glucophage)

4 Clomiphene (Clomid) and metformin (Glucophage) The patient has anovulation and insulin resistance. Therefore, the primary health care provider may prescribe a combination of clomiphene to promote ovulation and metformin to control blood sugar levels. Clomiphene increases pituitary production and increases the production of follicle-stimulating hormone. Insulin resistance causes hyperinsulinemia, which is a feature of polycystic ovary syndrome. This causes anovulation and leads to infertility in the patient. Danazol (Danocrine) is used for the treatment of endometriosis. Glipizide (Glucatrol) and glyburide (Diabeta) are oral hypoglycemic agents but do not work on patients with insulin resistance. Bromocriptine (Parlodel) is used for patients who have excess prolactin. Progesterone (Prometrium) is used for the treatment of endometriosis. Acarbose (Precose) works in the gastrointestinal tract on carbohydrates for diabetes mellitus.

A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? 1 Semen analysis 2 Testicular biopsy 3 Endometrial biopsy 4 Hysterosalpingogram

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

A patient wants to have an abortion during the 18th week of pregnancy. What abortion technique should the nurse suggest to the patient? 1 Dilation and evacuation 2 A surgical (aspiration) abortion 3 Administration of methotrexate (Trexal) 4 Administration of mifepristone (Mifeprex)

1 Dilation and evacuation The patient is in her second trimester of pregnancy. Therefore, the nurse should suggest the dilation and evacuation method of abortion. This method is safe and can be used until 20 weeks of gestation. Surgical (aspiration) methods and use of medications such as methotrexate (Trexal), mifepristone (Mifeprex), and misoprostol (Cytotec) are effective for abortion during the first trimester of pregnancy. These methods are not suitable as the patient is in the 18th week of pregnancy.

After having a discussion with a patient, the nurse finds that the patient has regular menstrual cycles every 28 days. What instructions should the nurse give to the patient to prevent conception? 1 The couple should abstain from sexual intercourse from days 10 through 17. 2 The couple should abstain from sexual intercourse from days 6 through 19. 3 It is safe to have unprotected sexual intercourse from days 11 through 17. 4 It is safe to have unprotected sexual intercourse from days 12 through 16.

1 The couple should abstain from sexual intercourse from days 10 through 17 The patient has regular menstrual cycles of 28 days. The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest cycle. The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. Therefore, according to the formula, the fertile days are from day 10 through day 17 (shortest cycle, 28 - 18 = day 10, and longest cycle, 38 - 11 = day 17). Therefore, the nurse should advise the patient to abstain from sexual intercourse between days 10 and 17. If the woman has a shortest cycle of 24 days and a longest cycle of 30 days, then the couple should abstain from sexual intercourse from days 6 through 19. As per the calculation, women who have regular cycles of 28 days should not have unprotected sexual intercourse between days 11 and 17 and days 12 through 16 because it is a fertile period.

The nurse is assessing a patient who is taking oral contraceptives and reports severe pain in the legs. What symptoms should the nurse primarily assess for in the patient? 1 Thrombus formation 2 Severe muscle spasms 3 High creatinine levels 4 Hyperglycemic events

1 Thrombus Formation Patients who take oral contraceptives are at a high risk of developing thromboembolism or blood clots. Therefore the nurse would primarily assess for calf pain warmth and tenderness which indicates thromboembolism. Muscle spasms are not side effects that develop with oral contraceptives. Although the pain is severe in the case of muscle spasms, it can be resolved easily with the help of analgesics. Creatinine levels increase when the kidneys fail to function properly. Oral contraceptives have no effect on kidney function. Oral contraceptives have no effect on blood glucose levels

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: 1 "The lubricant prevents vaginal irritation." 2 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." 3 "The additional lubrication improves sex." 4 "Nonoxynol-9 improves penile sensitivity."

2 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Nonoxynol-9 does not provide protection against sexually transmitted infections. 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.

Which contraceptive method provides protection against sexually transmitted infections? 1 Oral contraceptives 2 Tubal ligation 3 Male or female condoms 4 Intrauterine device (IUD)

3 Male or female condoms Because condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted infection. Only the barrier methods provide some protection from sexually transmitted infections. A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted infections. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted infections.

A 26-year-old woman is considering Depo-Provera as the contraception that is best for her because she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse should tell her that Depo-Provera: 1 is a combination of progesterone and estrogen. 2 is a small adhesive hormonal birth control patch that is applied weekly. 3 thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. 4 has an effectiveness rate in preventing pregnancy of 96% when used correctly.

3 thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. The effectiveness rate is 99% or greater over 5 years.

The nurse administers leuprolide acetate (Eligard) followed by gonadotropin therapy to a patient and schedules the patient for daily ultrasounds. What is the rationale for this referral? To check for: 1 Fibrocystic breast tissue changes. 2 Stimulation of the endometrium. 3 Blockage in the fallopian tubes. 4 Hyperstimulation of both ovaries.

4 Hyperstimulation of both ovaries. Leuprolide acetate (Eligard) followed by gonadotropin is the most powerful medication to induce ovulation. These medications require daily ovarian ultrasounds and checking of estradiol levels in order to assess for hyperstimulation of the ovaries. Breast tissue changes, endometrial stimulation, and fallopian tube blockage are not side effects related to gonadotropin drugs. Progesterone may cause breast enlargement and endometrial stimulation. Fallopian tube blockage must be corrected surgically.

On reviewing the laboratory report of the patient, the nurse finds that the patient is subfertile. Which nursing advice is helpful for the patient to resolve this condition? 1 Start taking cold baths or showers daily. 2 Take flaxseed oil in order to stimulate fertility. 3 Add periwinkle powder to your tea once a day. 4 Use water-soluble lubricants during intercourse.

4 Use water-soluble lubricants during intercourse. Commonly used lubricants contain spermicides or have spermicidal properties that can kill sperm. Therefore the nurse should advise the patient to use water-soluble lubricants during intercourse. The nurse should advise the patient to take hot baths or use saunas instead of cold baths and showers. This increases the basal body temperature, which helps in increasing spermatogenesis. Flaxseed and periwinkle herbal products should not be used, as most herbal remedies are not clinically proven. Hence, they may not be safe

The nurse is caring a patient who is pregnant as a surrogate mother. What condition would the biological mother have in order to need to use a gestational surrogate? 1 Ovarian failure 2 Tubal blockage 3 Early menopause 4 Uterine myoma

4 Uterine Myoma The patient who carries the fetus for another couple is referred to as a surrogate mother. In conditions like uterine myomas, the fertilized ova cannot be impregnated in the uterus of the biological mother. Therefore, the couple would need a surrogate mother to carry the fetus. A female with ovarian failure can still carry the fetus after in vitro fertilization of the donor oocyte. The genetic investment from the male parent can possibly be observed in the embryo when the oocyte is donated and fertilized with the parent sperm. In conditions like tubal blockage, a female can carry the fetus after it is fertilized in vitro. Genetic investment is possible from both the parents for the embryo. Early menopause is the condition where a female may require a donor oocyte to conceive and can still carry the embryo in her own uterus.

The nurse is assessing a couple for infertility problems. After reviewing the patient's history and laboratory results, the nurse finds that the patient is being treated with clomiphene (Milophene). However, there has not been an increase in the sperm count. What else could be added to the prescription that would help the patient to increase the sperm count? 1 Bromocriptine (Parlodel) 2 Progesterone (Prometrium) 3 Depot medroxyprogesterone acetate (DMPA) 4 Intracytoplasmic sperm injection (ICSI)

4 intracytoplasmic sperm injection The patient may require intracytoplasmic sperm injection (ICSI). This treatment is preferred for treating patients who have a low sperm count or reduced spermatogenesis. In this process, one sperm cell is selected and injected directly into the egg to achieve fertilization. Bromocriptine (Parlodel) is used to reduce excess prolactin levels. Progesterone (Prometrium) is used for the treatment of endometriosis. Progestin (DMPA) injections are used to impair fertility by inhibiting ovulation. These medications are not prescribed for infertility problems in males.

The nurse instructs a nursing student to administer clomiphene (Clomid) to a patient in order to conduct a clomiphene citrate challenge test (CCCT). What instruction should the nurse give to the nursing student before giving this medication to the patient? To administer: 1 A 100-mg dose of clomiphene (Clomid) to the patient immediately. 2 A 500-mg initial dose of clomiphene (Clomid) to the patient. 3 Clomiphene (Clomid) to the patient on the 12th day of the menstrual cycle. 4 Clomiphene (Clomid) to the patient on the 15th day of the menstrual cycle.

1 A 100-mg dose of clomiphene (Clomid) to the patient immediately. The clomiphene citrate challenge test is used to assess follicle-stimulating hormone (FSH) levels. From this test, the nurse can determine whether the patient has an adequate ovarian reserve. The nurse instructs the student nurse to administer a 100-mg dose of clomiphene (Clomid) to the patient, as it is the standard dosage. Administering 500 mg may lead to an overdose and side effects in the patient. Therefore, the nurse should not instruct the nursing student to administer 500 mg of clomiphene (Clomid) as the initial dosage. Administering clomiphene (Clomid) on the 12th or 15th day of the menstrual cycle may not be effective and does not affect the levels of follicle-stimulating hormone

The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus is: 1 In vitro fertilization 2 Tubal embryo transfer 3 Therapeutic insemination 4 Gamete intrafallopian transfer

1 In vitro fertilization 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 uses the partner's sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer involves placing the sperm and ova in the fallopian tube.

Which medication should the nurse expect to find in the patient's medication profile for the treatment of uterine fibroid tumors? 1 Leuprolide acetate (Lupron) 2 Ganirelix acetate (Antagon) 3 Progesterone (Prometrium) 4 Clomiphene citrate (Clomid)

1 Leuprolide acetate (Lupron) Gonadotropin-releasing hormone (GnRH) agonists like leuprolide acetate (Lupron) are used for the treatment of uterine fibroids. These medications desensitize the GnRH agonist receptors and decrease the production of follicle-stimulating hormone (FSH) and ovarian function. Ganirelix acetate (Antagon) is a GnRH antagonist and is used for infertility treatment. Progesterone (Prometrium) is used for treatment of luteal phase inadequacy. Clomiphene citrate (Clomid) is used for ovulation induction and treatment of luteal phase inadequacy.

What are the side effects of gonadotropin-releasing hormone (GnRH) agonists? Select all that apply. 1 Myalgia 2 Arthralgia 3 Lactic acidosis 4 Vaginal dryness 5 Liver dysfunction

1 Myalgia 2 Arthralgia 4 Vaginal dryness Gonadotropin-releasing hormone (GnRH) agonists are used for the treatment of endometriosis and uterine fibroids. Myalgia, arthralgia, and vaginal dryness are the side effects of gonadotropin-releasing hormone (GnRH) agonists. These side effects are usually reversible within 12 to18 months after the treatment. Lactic acidosis and liver dysfunction are side effects of metformin, which is an oral hypoglycemic agent.

A woman calls the clinic asking the nurse what to do for one missed combined oral contraceptive pill. Which instructions should the nurse give the woman? Select all that apply. 1 No backup method is needed. 2 Take the next dose at the usual time. 3 Take one active pill as soon as possible. 4 Take two pills then resume one tablet daily. 5 Use a backup contraceptive for the next seven days.

1 No backup method is needed. 2 Take the next dose at the usual time. 3 Take one active pill as soon as possible. For one missed combined oral contraceptive pill the nurse instructs the woman to continue the pack as usual, take the next dose at the usual time and take one active pill as soon as possible. Two pills should not be taken and no backup contraceptive is necessary.

The nurse is reviewing the laboratory results for a patient who has undergone semen testing. The nurse notices that the patient is in the subfertile stage. What is the next step that the nurse should take? 1 Plan to have the test repeated 2 Arrange for hormone level tests 3 Schedule a scrotal ultrasound 4 Counsel about infertility issues

1 Plan to have the test repeated A minimum of two seminal analyses are recommended before determining the cause of infertility or referring for further testing. If abnormalities are found during the first test, the nurse should plan for a second seminal analysis after a sufficient interval. If the second semen test also finds the patient to be in the subfertile range, then further investigation is needed. This can include assessing hormonal levels and sending the patient for an ultrasound. The nurse should proceed to counsel the patient only after all the diagnostic tests reveal infertility, not after the initial semen examination.

A patient approaches the primary health care provider due to ovulation problems. The nurse instructs the patient to return for a visit 7 days before the menstrual cycle. What is the reason for these instructions? 1 To assess the levels of progesterone in the patient 2 To determine the thickness of the uterine lining 3 To evaluate the viscosity of the cervical mucus 4 To assess the follicle-stimulating hormone (FSH) level

1 To assess the levels of progesterone in the patient Serum progesterone levels are tested seven days before the onset of the next estimated menstrual cycle. This test would help identify the progesterone levels in the patient. It helps to assess the corpus luteum and midluteal-phase progesterone levels as progesterone plays a role in ovulation and the menstrual cycle. The uterine cavity is observed by using an X-ray film during a hysterosalpingogram. This test does not need to be conducted at a particular time. The viscosity of the cervical mucus is assessed to determine if it is conducive for the penetration of the sperm. This can be checked at any point in time. Follicle-stimulating hormone (FSH) levels are determined on day 3 of menstruation to determine ovarian reserve.

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: 1 "I know the test will identify what is wrong." 2 "I'm sure that once you finish these tests your problem will be resolved." 3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." 4 "Once you've identified your problem, you may want to look at the option of adoption."

3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples" Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best 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, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts.

Which symptom should the nurse expect in a female patient who presents with elevated androgen levels? 1 Skin rashes and acne 2 Loss of body hair 3 Pigmentation changes 4 Decreased body weight

3 Pigmentation changes An increase in androgen (male sexual hormone) levels causes pigmentation changes in the patient. This is because the epidermis becomes coarse and thick. Increased androgen levels do not cause hypersensitivity or acne breakouts. Therefore, the patient may have neither skin rashes nor acne. Due to an increase in androgen levels, the patient may have an excessive growth in body hair. Androgen levels do not affect body weight.

What factors should the nurse assess in the patient with anovoluation? Select all that apply. 1 Endometriosis 2 Vaginal infections 3 Thyroid disorders 4 Pituitary gland disorders 5 Pancreatic gland disorders

3 Thyroid disorders 4 Pituitary gland disorders Thyroid disorders and pituitary gland disorders are the primary factors causing anovulation. Abnormal activity of these glands could restrict the formation of ova. Endometriosis is the condition that affects peritoneal factors. This condition does not affect the formation of ova, nor does it restrict it. Vaginal infections are treated with medications and have no relation to the ovaries or their functioning. The pancreas secretes insulin and glucagon, which is not related to ovarian activity either.