SS PrepU Ch. 7

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?

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

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."

A couple has just learned that their son will be born with Down syndrome. The nurse shows a lack of understanding when making which statement?

"I will alert your entire family about this so you don't have to."

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."

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

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?

"Women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them."

Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?

12

A client asks the nurse about rate of fertility for women older than 35 years. Which of the following responses from the nurse is accurate?

A woman's fertility peaks in her 20s, declines gradually until age 35, and then rapidly declines until it ends.

The experienced nurse working in a fertility clinic understands the stress couples experience when they have to "schedule" sexual relations. Which suggestion would be most helpful to a couple to help prevent further stress on their relationship?

Begin a new activity together.

What advice can the nurse give a female patient trying to conceive to facilitate sperm collection to the cervix?

Elevate the hips on a small pillow after coitus.

A nurse is visiting with a couple who has recently completed subfertility assessments and are awaiting the results. Throughout the conversation the wife intermittently begins to cry. What would be the most appropriate nursing diagnosis for this couple?

Fear related to possible outcome of subfertility studies

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

General health Medication history Sexual history Surgical history

A couple who has not conceived after 6 years of not using birth control are being seen in the infertility clinic. In assessing the client's psychosocial response to infertility, which might the nurse expect to find? Select all that apply.

Guilt related to the lack of conception Anger toward others who have conceived Fear of the possible outcome of the testing

The nurse is assessing a man concerned about his ability to father children because he has an "abnormality of the penis." The nurse finds that the urethral opening is on the ventral surface of the penis. How would the nurse document this finding?

Hypospadias

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

A couple has just learned that their unborn son has a chromosome disorder that results in an extra X chromosome. The primary care provider explains that secondary sex characteristics will not develop in this child at puberty and that his testes will remain small and produce ineffective sperm. The nurse recognizes that this child likely has:

Klinefelter syndrome.

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 1 year of engaging in unprotected coitus.

A couple has just undergone a semen analysis. The semen sample was visualized under the microscope, and the nurse tells the couple that they must return to do another semen analysis. The man states that he can return later in the week. What is the best answer the nurse can provide?

The analysis will need to be repeated after 2 or 3 months because spermatogenesis is an ongoing process, and 30 to 60 days are needed for sperm to reach maturity.

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?

The couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count.

A female client is having a procedure this morning that involves radiologic examination of the fallopian tubes using a radiopaque medium. What procedure should the nurse document as being performed?

a hysterosalpingography

A couple is discussing starting a family with the nurse. When should the nurse suggest genetic counseling?

before they conceive

A client is being prepared for artificial insemination. Which finding is the most suggestive to determine if the client is ovulating?

change in the cervical mucus

A nurse is assessing a client who has a history of pelvic inflammatory disease (PID). The nurse would be alert for which complication? Select all that apply.

ectopic pregnancy pelvic abscess fibrosis

A young client has just been told by her primary care provider that she has a problem with ovulation. Which treatment would the nurse expect the care provider to prescribe for this client?

hormones

A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the:

phenotype.

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.

semen analysis ovulation monitoring tubal patency

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

Which condition is the most commonly occurring chromosomal disorder?

trisomy 21

Parents of a newborn have recently found out that their infant has a genetic disorder. The parents say to the nurse, "It's not fair that this is happening to us." The nurse interprets this statement as reflecting which stage of grief?

anger

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? "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 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

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?

secondary erectile dysfunction

A couple informs the nurse that they have not been able to conceive for the last year. During assessment, the nurse learns that the couple has a 3-year-old daughter and 7-year-old son. They report having had no problems getting pregnant the other times. Which type of fertility is this couple exhibiting?

secondary subfertility

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?

Wear cotton underwear

A nurse has completed her assessment of a male patient for subfertility. Which finding would the nurse interpret as increasing the patient's risk for experiencing a limited sperm count?

Working at a desk job

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?

Chart body temperature for at least a month

A female patient who has been trying to conceive for 1 year comes to the fertility clinic and will be undergoing a subfertility evaluation. When discussing the components involved, which information would the nurse most likely include? Select all that apply.

semen analysis of the partner ovulation monitoring tubal patency assessment

A nurse is conducting a health history on a male client. Which statement by the client related to the client's fertility would concern the nurse?

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

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."

The nurse is seeing a client who is going to be married in a month. This client has a history of Huntington disease in her family. The genetic testing has come back, and the client has just been told she carries the gene for Huntington disease and will develop the disease when she gets older. The client asks the nurse if this information is confidential and if it will remain that way. The nurse explains to the client that her family should be told and so should her fiancé. The client forcefully tells the nurse "no." She is not going to tell either her family or her fiancé. What is the nurse's best response?

"I will respect your wishes and keep your information confidential. I do wish you would reconsider though"

After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing abnormal uterine bleeding. Which statement by the client would support the nurse's suspicions?

"I've been having bleeding off and on that's irregular and sometimes heavy."

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 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?

"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 female client comes to the clinic and asks the nurse what would be the most cost effective method for her to determine her ovulation patterns. What is the best response by the nurse?

"The least costly method to determine ovulation patterns is to record the basal body temperature for at least 4 months."

A nurse is reviewing the medical record of several couples who have attempted to conceive but have been unsuccessful. Which couple would the nurse most likely identify as benefitting from in vitro fertiliziation (IVF)? Select all that apply.

A woman who has blocked or damaged fallopian tubes A man who has oligospermia A woman who lacks cervical mucus A couple with unexplained subfertility of long duration

A 38-year-old woman comes to the clinic to discuss discontinuing use of her birth control pills and attempting conception. She says to the nurse, "I know a lot of women who have waited later to have children and don't have any problem." What is the best response by the nurse?

"Women in their late 30s who use oral contraception may face a delay in conception for several months, because the body has to return to normal function before conception is possible."

A nurse in an infertility clinic correctly identifies which of the following patients to be at highest risk for not conceiving?

23 year old with anorexia who runs 5 miles a day

A 40-year-old client is a high profile local politician and exercises on a daily basis. She states to the clinic nurse "We stopped using birth control 7 months ago and I still have not gotten pregnant. Should we be worried?" What is the nurse's best response?

"You should tell the health care provider today during the visit."

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?

Compromised or absent fertility

Inability to conceive can be very stressful on a couple. What is one psychological aspect of infertility?

Loss of intimacy

A woman who has been trying to conceive has been diagnosed with multiple myomas of the uterus. What option is available for the woman to be able to conceive?

Myomectomy

A client is scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs?

Priapism

A 23-year-old client who's 27 weeks pregnant arrives at her physician's office with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. Which condition would the nurse most likely suspect?

Pyelonephritis

A young couple is having difficulty getting pregnant. The nurse is preparing the couple for the initial tests to determiine their fertility. When asked by the couple why they need to start with a sperm analysis, what will be the nurse's best response?

Sperm analysis is one of the easiest tests to complete.

A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications?

Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule.

A nurse is present when a health care provider tells a couple that the results of their genetic testing came back normal. Later, the nurse notes that the completed genetic report identifies the couple positive for a genetic disorder. What is the most appropriate action by the nurse?

Report it to the nursing supervisor.

A couple has come to the infertility clinic because they have been unable to get pregnant even though they have been trying for over a year. Diagnostic tests are planned for the woman to ascertain if ovulation is regular and whether her endometrium is adequately supported for implantation. What test would the nurse expect to have ordered for this woman?

Serum progesterone

A female patient 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 nurse has been working with a subfertile couple through the process of determining their best plan of action to conceive a child. Which action should the nurse prioritize to provide emotional support to this couple?

Speak both separately and together with both partners.

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?

Spiritual distress related to inability to conceive

In developing a plan of care for a 5-year-old child with Down syndrome, what should be a priority for the nurse in meeting the expected growth and development outcomes for this child?

The child is enrolled in kindergarten.

Which outcome would be most appropriate for the nurse to establish for a client who has a myomectomy with an intrauterine device placed?

The client will have the IUD removed in 1 month

A woman trying to conceive has been prescribed metronidazole (Flagyl) for bacterial vaginosis. What should the nurse caution this patient while taking this medication?

This drug can be teratogenic early in pregnancy and shouldn't be continued if a pregnancy is suspected.

Genetics-related health care is basic to the holistic practice of nursing. What should nursing practice in genetics include?

gathering relevant family and medical history information

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

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?

no or few sperm cells produced

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about?

overstimulation of the ovary resulting in potential multiple births

A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply.

ovulation tubal transport impaired implantation

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:

polycystic ovarian syndrome.