OB Chapter 7

A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make?

"I will call the health care provider to come visit with you."

A nurse is conducting an assessment on a female client being seen for infertility issues. Which assessment data leads the nurse to believe that anovulation is occurring? Select all that apply. Blood pressure 112/68 mmHg Unmarried BMI 14.6 Menses started at 14 No fluctuation on BBT graph

BMI 14.6 No fluctuation on BBT graph

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? 2 to 5 ml of semen ejaculated no or few sperm cells produced sperm density about 20 million/ml morphology of sperm within normal limits

no or few sperm cells produced

A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client? the vas deferens the epididymis the scrotum the ejaculatory ducts

the vas deferens

A female client reports difficulty becoming pregnant despite having coitus daily for the past 2 months. Which advice will the nurse recommend? "You should begin considering in vitro fertilization." "Avoid having coitus every day because this may lower your partner's sperm count." "Elevate your hips on a small pillow after coitus to improve sperm motility." "Douche immediately after coitus to push the sperm through the cervix."

"Avoid having coitus every day because this may lower your partner's sperm count."

Semen analysis has been ordered for the partner of a client who has been unable to become pregnant. What instructions should the nurse provide to the partner? "Collect the sample after two consecutive days of ejaculating." "Keep the sample refrigerated to ensure the sperm survive." "If possible, collect the sample first thing in the morning." "Bring the sample to the lab immediately after you collect it."

"Bring the sample to the lab immediately after you collect it."

A client is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that she needs further teaching? "I will receive fertility drugs to stimulate ovulation." "The primary care provider will transfer my fertilized eggs into the uterus." "The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." "The primary care provider will harvest eggs from my ovary."

"The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized."

When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply. Medication history General health Surgical history Sexual history School history

General health Medication history Sexual history Surgical history

A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client? In vitro fertilization Gamete intrafallopian transfer Surrogate mother Ovulation stimulation

In vitro fertilization

A couple consults with the nurse regarding their infertility issues. The female says "I don't know what I have done so bad that God would punish me like this." What would be the most appropriate nursing diagnosis for this couple? Hopelessness related to inability to conceive Spiritual distress related to inability to conceive Anticipatory grieving related to infertility Powerlessness related to infertility

Spiritual distress related to inability to conceive

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? Subfertility is said to exist when a pregnancy has not occurred after at least 6 months of engaging in unprotected sex. Subfertility is said to exist when a pregnancy has not occurred after at least 3 months of engaging in unprotected sex. Subfertility is said to exist when a pregnancy has not occurred after at least 2 years of engaging in unprotected sex. Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected sex.

Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected sex.

A client is being prepared for intrauterine (artificial) insemination. Which finding is the most suggestive to determine if the client is ovulating? slight weight gain fall in body temperature change in the cervical mucus abdominal cramps SUBMIT ANSWER

change in the cervical mucus

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? extensive bleeding during menstruation elevation of her blood glucose level overstimulation of the ovary resulting in potential multiple births hypertension

overstimulation of the ovary resulting in potential multiple births

A male client 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? sterility secondary erectile dysfunction tertiary erectile dysfunction primary erectile dysfunction

secondary erectile dysfunction

The nurse is conducting a health history on a couple planning to become pregnant over the next few months. Which statement by the male client most concerns the nurse? "I consume fast food a few times each week and enjoy a few beers on the weekends." "I have severe asthma and use my inhaler several times each month." "I have a degree as a chemical engineer and work at the local plant." "My uncle and his wife have not been able to conceive a child."

"I have a degree as a chemical engineer and work at the local plant."

A nurse is reviewing sperm count results for a couple trying to conceive. Which results would concern the nurse? 10 million per ml of seminal fluid 20 million per ml of seminal fluid 40 million per ml of seminal fluid 30 million per ml of seminal fluid

10 million per ml of seminal fluid

The nurse is preparing to assess a client who is noted to have a history of dysmenorrhea. The nurse predicts the client will report which potential symptom during the examination? chronic pelvic pain intermittent, sharp suprapubic pain abnormally long, heavy menstrual periods dysphoria

intermittent, sharp suprapubic pain

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? semen analysis, urinalysis, and ovulation monitoring semen analysis, ovulation monitoring, and tubal patency assessment serologic test for syphilis, semen analysis, and tubal patency assessment pelvic sonogram, ovulation monitoring, and semen analysis

semen analysis, ovulation monitoring, and tubal patency assessment

A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions? "They will surgically implant the ovum during the procedure." "They will place a catheter in my uterus and use an ultrasound to see what the problem is." "This is just an ultrasound procedure, like they do for a baby." "I will be put under general anesthesia for the procedure."

"They will place a catheter in my uterus and use an ultrasound to see what the problem is."

A female client complains of irregular menses. On further assessment, the nurse observes that the client is obese and is developing hirsutism. Her diagnosis indicates an ovarian dysfunction with increased levels of testosterone. The nurse interprets these findings to suggest: adrenal hyperplasia. premature ovarian failure. polycystic ovary syndrome. hypothyroidism.

polycystic ovary syndrome.

A young woman is having trouble conceiving and has come to the office for fertility testing. She states that she has irregular and unpredictable menstrual cycles. On blood testing, it is found that her ovaries are producing excess testosterone, which is lowering her follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Which of the following is the most likely cause of her subfertility? endometriosis anovulation stenotic cervical os tubal transport problems

anovulation

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. in vitro fertilization counseling tubal patency ovulation monitoring fertility drugs semen analysis

semen analysis ovulation monitoring tubal patency

A nurse is preparing to sign an informed consent form for a client undergoing an hysterosalpingogram. Which statement by the client indicates a correct understanding of the procedure? "I have a fibroid tumor that will be removed with this procedure." "This will break up the scar tissue from the infection that I had 3 years ago." "I was born with only one ovary, so this will help the physician see it." "I broke my pelvis as a child so this will help me carry a fetus."

"This will break up the scar tissue from the infection that I had 3 years ago."

A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client? Record body temperature every night Record menses and time of intercourse Chart body temperature for at least a month Record body weight along with the temperature

Chart body temperature for at least a month

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? abstain from sexual intercourse Restrict the intake of salt in the diet clean from back to front after urination wear cotton underwear

wear cotton underwear

A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? "Diet does not play a role in infertility." "An absence of ovulation may cause infertility." "A genetic abnormality may cause infertility." "Exercise can influence infertility."

"Diet does not play a role in infertility."

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. "Do you use drugs or use alcohol excessively? "Have you ever had any type of trauma or surgery on or near your testicles?" "When was the last time you had sex?" "Are you exposed to X-rays or other radioactive substances?" "Do you have a regular girlfriend?"

"Do you use drugs or use alcohol excessively? "Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?"

A nursing instructor is teaching about fertility and realizes a need for further instruction when a student states: "In most couples with a subfertility problem, it is the man who is subfertile." "Sterility is the inability to conceive because of a known condition, such as absence of a uterus." "In primary subfertility, there have been no previous conceptions." "In secondary subfertility, there has been a previous viable pregnancy."

"In most couples with a subfertility problem, it is the man who is subfertile."

A female client has been trying to conceive for 3 months. She tells the nurse, "I just know something is wrong with me." Which response by the nurse is best? "The problem can be with the man, woman, or both. We will explore all possibilities." "It is time to talk to your health care provider about hormone testing." "It can take up to 1 year of regular, unprotected intercourse to conceive." "Do you or your partner have a family history of subfertility?"

"It can take up to 1 year of regular, unprotected intercourse to conceive."

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? "Men can have increased prolactin levels that decrease sperm viability." "Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen." "Men may not have enough estrogen and FSH in their bodies to maintain testicular function." "Men may ejaculate into the bladder instead of the vagina."

"Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen."

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? "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." "Weight has no bearing on the ability to conceive. Something else must be going on with your reproductive organs." "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." "Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering."

"Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering."

A couple went through subfertility testing and was told that everything looks normal. After 4 months, the couple still has not conceived. The couple comes to the clinic stressed and depressed, unsure of their next option. One spouse tells the nurse that they seem to argue all the time now and does not know if all this is worth it. How will the nurse respond? "I worry about your stress level. You need to relax more and it will happen." "I know this is stressful. Let me know how I can help you." "It does seem like you should briefly focus on something else to regain perspective." "Perhaps a support group will help you both work through this stress."

"Perhaps a support group will help you both work through this stress."

A 38-year-old client wishes to discontinue use of birth control pills and attempt to conceive. The client says to the nurse, "I know a lot of women who have waited later to have children and became pregnant easily." How will the nurse respond? "As soon as you stop taking the pill, you should be able to conceive. There are no age-related problems with you becoming pregnant." "You should be off of oral contraceptive pills for at least 1 year before trying, and then you may or may not be able to become pregnant." "The age of a woman does not matter when trying to conceive, but you have been on birth control for a long time, thus it may take you longer." "Women in their late 30s who use oral contraceptive pills may face a delay in conception, as the body takes a few months to be able to conceive."

"Women in their late 30s who use oral contraceptive pills may face a delay in conception, as the body takes a few months to be able to conceive."

A client states she has purchased home-use ovulation strips to help her know when she is ovulating. Which response by the nurse is most appropriate? "I am sure these strips will help you become pregnant faster." "These strips are often not reliable and end up being a waste of money." "You can also test your vaginal discharge to determine if you are ovulating." "It is a lot more accurate if you come to the clinic routinely to get tested."

"You can also test your vaginal discharge to determine if you are ovulating."

The nurse is assessing a man concerned about infertility because he has an "abnormality of the penis." The nurse finds that the urethral opening is on the ventral surface of the penis. Which instruction is important at this time? "I will document this as an abnormality that causes sterility." "This condition causes erectile dysfunction, which we have medication to treat." "This condition will have no impact on reproduction abilities. Keep trying." "You have hypospadias. It may cause difficulty, but your sperm is still viable."

"You have hypospadias. It may cause difficulty, but your sperm is still viable."

The experienced nurse working in a fertility clinic identifies concerns of clients when they have to schedule sexual relations. Which nursing suggestion would be most helpful to a couple to help prevent further stress on their relationship? Avoid talking about the overall cost of fertility treatment. Take up new individual hobbies. Begin a new activity together. Try to relax and enjoy it.

Begin a new activity together.

A 31-year-old client is preparing to undergo a second round of in vitro fertilization (IVF). In the first round of IVF the client had 5 viable embryos and 2 were implanted; this pregnancy resulted in a spontaneous abortion (miscarriage) at 6 weeks. The client asks if the remaining 3 embryos can be implanted in the second round. How should the nurse respond to this request? Guidelines for clients your age are that only 1 to 2 embryos should be implanted to avoid risks of complications from a multiple gestation. Because you were able to get pregnant with the first round of IVF, we recommend only one embryo be implanted with this round. If we implant 2 embryos again that leaves one for a third round of IVF if needed. You will need to ask your health care provider for special permission to increase the number to 3 embryos.

Guidelines for clients your age are that only 1 to 2 embryos should be implanted to avoid risks of complications from a multiple gestation.

A female client had a diagnostic laparoscopy and is now reporting a sharp pain in her shoulder. What response is a priority by the nurse? Some of the carbon dioxide that was used to insufflate the abdomen has likely escaped under the diaphragm and this will resolve on its own. The client may be having a myocardial infarction from the stress of the procedure and the nurse should begin cardiac protocols. The client is probably having a pulmonary embolus and should be administered anticoagulation drugs immediately. The client has possibly developed aspiration from stomach contents related to anesthesia.

Some of the carbon dioxide that was used to insufflate the abdomen has likely escaped under the diaphragm and this will resolve on its own.

A client is to take clomiphene citrate for infertility. Which outcome should the nurse explain is the expected action of this medication? Stimulate the release of ova Decrease testosterone levels Reduce inflamed endometrium Break down scar tissue

Stimulate the release of ova

A female client had a tubal ligation 8 years ago. She has remarried, would like to have a child with her current husband, and is requesting a surgical procedure to reopen the tubes. Which information would the nurse most likely include when discussing the success rate for this procedure? The success rate of the operation is not greater than 70% to 80%. The success rate of the operation is not greater than 20% to 30%. The success rate would be zero after this this length of time. The success rate of the operation is not greater than 50% to 60%.

The success rate of the operation is not greater than 70% to 80%.

A woman trying to conceive has been prescribed metronidazole for bacterial vaginosis. What should the nurse caution this client while taking this medication? This medication is safe for use in pregnancy. This drug can be teratogenic early in pregnancy and she should inform the health care provider if pregnancy is suspected. This drug is the only treatment for bacterial vaginosis and must be taken as prescribed even if pregnancy is suspected. The medication will be continued to treat the infection. She will be monitored closely if she discovers she is pregnant.

This drug can be teratogenic early in pregnancy and she should inform the health care provider if pregnancy is suspected.

A nurse is assessing a man who, along with his partner, has been having trouble conceiving. When assessing the man, which area would the nurse most likely include as possibly affecting his fertility? history of a fractured bone history of a sexually transmitted disease history of mental illness testes exposed to radiation a job that requires sitting all day a 24-hour food intake

a 24-hour food intake history of a sexually transmitted disease testes exposed to radiation a job that requires sitting all day

A female client who comes to the clinic for a visit is diagnosed with Turner syndrome. The nurse would expect the client to experience which of the following? compromised or absent fertility development of cystic fibrosis in male offspring development of respiratory distress syndrome in her infant maternal tubal problems

compromised or absent fertility

A 40-year-old female client with a chronic pelvic infection expresses her desire to conceive post-treatment. When discussing this with the client the nurse keeps in mind that the client is at increased risk for which of the following? gestational diabetes ectopic pregnancy decreased menses symptoms of menopause

ectopic pregnancy

A clinic nurse explains to a client who is undergoing an infertility workup that the patency of her fallopian tubes will be checked. Which test is currently used to do this? hysterosalpingography computed tomography scan magnetic resonance imaging uterine biopsy

hysterosalpingography