common reproductive prepU

Combined oral contraceptives

"the pill" suppresses ovulation through the combined actions of estrogen and progestin

basal body temperature

A birth control based on body temperature and time for ovulation

The nurse is asked to schedule a hysterosalpingogram. Which question would be most important for the nurse to ask the woman before scheduling the procedure? When do you expect your next menstrual flow? Are you allergic to any sedatives? What is your blood type and Rh factor? When did you have coitus last?

Because a radiograph is involved, the procedure should be done in the few days following a menstrual flow when she is not apt to be pregnant.

aches (complications for oC)

Abdominal pain Chest pain Headaches Eye problems Severe leg pain

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will: increase a degree. decrease a degree. fluctuate a degree daily. no longer reflect basal body temperature.

The effect of progesterone, released with ovulation, is to increase body temperature.

The estrogen content in the contraceptive pill performs which action? decreases the permeability of cervical mucus increases the level of luteinizing hormone (LH) interferes with endometrial proliferation suppresses follicle-stimulating hormone (FSH)

Estrogen has a direct effect on the pituitary gland suppressing FSH; progesterone increases permeability of cervical mucus and endometrial proliferation.

how estrogen effects FSH

Estrogen is at a low point. Therefore, the pituitary secretes FSH and LH, a process which actually begins before the onset of your menses. These hormones in turn stimulate the growth of several ovarian follicles, each containing one egg.

A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common? endometriosis multigravida status hormonal imbalance perimenopause

Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities.

A nurse is teaching a couple about how to use a condom. The nurse determines the couple can properly apply the condom when they state that it should be applied at which time to be most effective? as part of foreplay at least 1 hour prior to coitus before penile-vulvar contact immediately after ejaculation

Some sperm may be released with pre-ejaculation semen, so a condom needs to be used with any penile-vulvar contact. It is best applied when the penis is erect. It is not necessary to apply an hour in advance. Waiting until after ejaculation would not be effective. It can be part of the foreplay, however, the primary goal is to prevent sperm from entering the vagina, so it should be in place before any penile-vulvar contact occurs.

After assessing a client, a nurse determines that an IUD as a method of contraceptive would be contraindicated based on a history of which finding? Smoking Hypertension Abnormal uterine shape Thromboembolic disease

Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape (the device might perforate the uterine wall). The copper IUD use also is not advised for a woman with severe dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding) because use may increase the incidence of these conditions. Because use of a copper IUD can cause heavier than usual menstrual flow, a woman with anemia also may not be considered a good candidate for a copper IUD. The other findings are not contraindications. .

The nurse is teaching a client about a vasectomy. The nurse determines the session is successful when the client correctly chooses which fact concerning the vasectomy? Usually done as an office procedure Will no longer ejaculate May notice permanent increased scrotal swelling Testes will no longer produce sperm.

Vasectomy is an outpatient surgical procedure which is usually performed in the office. It involves ligating and cutting the vas deferens, which stops the flow of sperm from the testes to the outside of the body; however, it does not stop sperm production. There may be short-term swelling immediately after the procedure, but there should not be any permanent swelling. The patient should still have normal sexual function.

A client reports that she has multiple sex partners and has a lengthy history of various pelvic infections. She would like to know if there is any temporary contraceptive method that would suit her condition. Which method should the nurse suggest for this client? intrauterine device (IUD) condoms oral contraceptives (OCs) tubal ligation

Because the client has multiple sex partners, condoms will help offer protection against sexually transmitted infections (STIs) and are best suited for her needs. The client cannot use an IUD because of her history of various pelvic infections. Although OCs will help the client as a means of contraception, this method is not the best choice for her because it does not offer protection against STIs. Tubal ligation is a sterilization procedure and does not suit the client's purpose.

A client presents at the clinic and is interested in obtaining emergency contraception (EC). The nurse explains that EC must be used within 72 hours of unprotected sex to be effective. This is because: ECs simply prevent embryo creation and uterine implantation from occurring in the first place. ECs can induce an abortion of a recently implanted embryo. ECs can help prevent STIs. ECs are more effective than regular birth control.

ECs prevent the embryo creation and uterine implantation from occurring. There is no evidence that ECs have any effect on an already-implanted ovum or that they induce abortion. They do not protect against STIs and are less effective than regular birth control.

A nurse is preparing a client for intrauterine device (IUD) insertion. What should the nurse inform the client when educating her on IUDs? There is reduced menstrual flow after insertion. The insertion procedure is painless. A regular check of threads must be done. There are continuous cramps after insertion.

The nurse should instruct the client to check the threads regularly to make sure that the IUD is in place. Menstrual flow may be heavier, or last longer than normal, after IUD insertion. It will not decrease. The client may feel a sharp pain when the IUD is inserted. The client may have cramps for a few days, but these should not continue.

A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications? Walk several times a week, maintain a regular sleep schedule, decrease complex carbohydrates, and avoid complex sugars. Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule. Walk every day, increase caffeine and salt intake, and sleep 8 to 10 hours a night. Reduce caffeine, perform cardio exercise 3 times a week, and sleep 12 hours every other night.

A healthy lifestyle contributes to a general sense of well-being. Encourage regular exercise, reduction or elimination of caffeine and alcohol, and adequate and regular sleep.

Lactational Amenorrhea Method (LAM)

A method of avoiding pregnancies based on the postpartum infertility that many women experience when they are breast-feeding.

What can the nurse educate a subfertile couple about to avoid the problem with lower sperm counts in the male partner? Avoid exercise regimens. Minimize actions that increase scrotal heat. Sit in a hot bath twice daily to increase the scrotal heat. Use the sauna after an exercise regimen to "sweat out" the toxins.

Actions that increase scrotal heat, such as working at desk jobs or driving a great deal every day, may produce lower sperm counts compared with men whose occupations allow them to be ambulatory at least part of each day. Frequent use of hot tubs or saunas may also lower sperm counts appreciably.

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

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.

risk factors for male infertility

Exposure to toxic substances (lead, mercury, x-rays, chemotherapy) Cigarette or marijuana smoke Heavy alcohol consumption Use of prescription drugs for ulcers or psoriasis Exposure of the genitals to high temperatures (hot tubs or saunas) Hernia repair Obesity is associated with decreased sperm quality Cushing syndrome Frequent long-distance cycling or running STIs Undescended testicles (cryptorchidism) Mumps after puberty

Which definition best explains the term "subfertility/infertility"? failure to achieve pregnancy after 6 months of unprotected intercourse failure to achieve pregnancy after 1 year of unprotected intercourse inability to achieve pregnancy because of a known factor that prevents conception inability to achieve pregnancy following a previous viable pregnancy

Infertility is the failure to achieve conception after 1 year of unprotected intercourse.

Which statement best explains the action of the lactational amenorrhea method (LAM) of fertility control? LAM causes suppression of the ovulation process. LAM prevents introduction of sperm into the vagina. LAM prevents fertilization between the egg and sperm. LAM thickens the cervical mucus and blocks sperm.

LAM prevents pregnancy by suppressing the ovulation process. Withdrawal and barrier methods of contraception prevent the introduction of sperm into the vagina. The copper IUD, combined hormonal methods, and combined oral contraceptives prevent fertilization between the egg and the sperm. Levonorgestrel system thickens the cervical mucus and blocks sperm.

What are methods for delivering hormonal contraception? Select all that apply. orally transdermally vaginally rectally implantation injection

Methods to deliver hormonal contraception include orally, transdermally, vaginally, implantation, and injection.

A nurse is teaching a woman how to use the basal body temperature method of contraception. the nurse determines that the teaching was successful when the woman identifies that she should refrain from having sexual intercourse at which time? 4 days after she notices her temperature rise. 7 days after noting a slight increase followed by a dip in her temperature. 3 days after she records a slight drop in her temperature followed by an increase. 14 days after the last day of her menstrual period.

Ovulation occurs after a slight drop in temperature followed by an increase. The ovum has a life span of 3 days. As soon as a woman notices a slight dip in temperature followed by an increase, she knows she has ovulated. She refrains from having coitus (sexual relations) for the next 3 days (the possible life of the discharged ovum).

Drugs for Medical Abortion

The first drug is methotrexate (an antineoplastic agent; Rheumatrex) followed by misoprostol (a prostaglandin agent; Cytotec) given as a vaginal suppository or in oral form 3 to 7 days later. Methotrexate induces abortion because of its toxicity to trophoblastic tissue, the growing embryo. Misoprostol works by causing uterine contractions, which helps to expel the products of conception. This method is 90% to 98% successful in completing an abortion The second drug used to induce first-trimester abortions involves using mifepristone (a progesterone antagonist; Mifeprex, RU-486) followed 48 hours later by misoprostol (a prostaglandin agent), which causes contractions of the uterus and expulsion of the uterine contents

After teaching a woman who has chosen the vaginal ring as her method of contraception, the nurse determines that the client needs additional teaching when she makes which statement? "It must be centered on my cervix to be effective ." "I'll compress the ring, inserting it as far back as possible." "I will insert a new ring at the same time and day of every week." "Once I remove the ring, I'll discard it."

The vaginal ring involves a 3-week period of continuous use followed by a ring-free week to allow withdrawal bleeding. The ring is compressed and inserted into the vagina, as far back as possible, but precise placement is not critical. After 3 weeks, the ring is removed and discarded.

A perimenopausal woman asks for help in selecting a contraceptive. She reports vaginal dryness during intercourse and says that her partner does not like the feel of condoms. Which method should the nurse recommend? spermicide female condom cervical cap diaphragm

Women older than 35 years have a higher incidence of cystocele or rectocele than younger women, so diaphragms or cervical caps may not be the ideal contraceptive for them. Spermicide foam can help lubricate the vagina to increase sexual enjoyment in women nearing menopause. Her partner's dislike of condoms rules out the female condom.

The nurse is providing contraception counseling to a perimenopausal woman who has had negative reactions to oral contraceptives in the past and would like a long-term, nonhormone-based method that has a high rate of success. Neither she nor her husband wants to undergo surgery, however. Which method should the nurse recommend? intrauterine device transdermal patch subdermal progestin implant tubal ligation

Women who are premenopausal are, overall, good candidates for intrauterine devices (IUDs). In this case, the IUD is the best choice because this method is almost 100% effective, is long-term, and does not involve any hormones. Both the transdermal patch and the subdermal progestin implant involve hormones, which rules each out in this case. Also, tubal ligation is a surgical procedure, which also rules it out for this client.

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 2 to 5 mL of semen ejaculated sperm density about 20 million/mL morphology of sperm within normal limits

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.

The nurse is teaching a young couple, who desire to start their family, the various methods for determining fertility. After discovering the woman regulary travels internationally for work, deals with a lot of job anxiety and frequently uses an electric blanket at home, the nurse will discourage the use of which method? calendar method basal body temperature method cervical mucus method symptothermal method

BBT is a method where the body temperature should be checked first thing in the morning and recorded, immediately after waking and before getting out of bed. It is important for the patient to maintain a normal bedtime routine. Use of the electric blanket, stress, and anxiety can cause a false elevation in the BBT. The calendar method would depend upon her schedule. Cervical mucus and symptothermal methodology would be viable options.

A 52-year-old client is seeking treatment for menopause. She is not very active and has a history of cardiac problems. Which therapy option should the nurse recognize as contraindicated for this client? long-term hormone replacement therapy selective estrogen receptor modulators lipid-lowering agents bisphosphonates

Because the client has a history of cardiac problems, long-term hormone replacement therapy is contraindicated. This is because there is an increased risk of heart attacks and strokes. The client should instead be asked to consider options with minimized risk, such as lipid-lowering agents, or nonhormonal therapies, such as bisphosphonates and selective estrogen receptor modulators.

A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide? "Replace the diaphragm every 6 months." "Have your diaphragm refitted if you lose 10 pounds (4.5 kilograms) or more." "Keep the diaphragm in place for no more than 4 hours after intercourse." "Wet the diaphragm with water first before inserting it."

Diaphragms should be refitted after pregnancy, abdominal or pelvic surgery, or weight loss or gain of 10 pounds (4.5 kilograms) or more. A diaphragm usually is replaced every 1 to 2 years. A diaphragm should remain in place for at least 6 hours after intercourse. A contraceptive sponge, not a diaphragm, should be wetted with water before insertion.

OC mechanism of action

OCs work primarily by suppressing ovulation by adding estrogen and progesterone to a woman's body, thus mimicking pregnancy. This hormonal level stifles GnRH, which in turn suppresses FSH and LH and thus inhibits ovulation. Cervical mucus also thickens, which hinders sperm transport into the uterus. Implantation is inhibited by suppression of the maturation of the endometrium and alterations of uterine secretions

During a routine health visit for an 11-year-old girl, her mother asks the nurse, "My daughter just got her period about 4 months ago, but they haven't been very regular so far. How long might it take until she gets regular?" Which response by the nurse would be most appropriate? "It can take up to 2 years once she starts for the periods to become regular." "She should start getting regular after about 2 to 3 more months." "That's odd. Her periods should be getting regular by now." "If her periods are not regular now, odds are they will be irregular from now on."

Once menarche has occurred, cycles may take up to 2 years to become regular, ovulatory cycles. Telling the mother that her daughter's periods would get regular in 2 to 3 months or that she should be having regular periods by now is incorrect. Also, telling the mother that her daughter's periods will continue to be irregular is untrue and inappropriate.

The nurse is meeting with a 36-year-old client who wishes to begin using contraceptives. The client reports being in a long-term, monogamous relationship, runs 2 miles per day, and smokes a pack of cigarettes each day. Which method will the nurse be least likely to suggest to the client? combination oral contraceptives condoms coitus interruptus spermicides

Oral contraceptives are contraindicated for women who smoke; they would be at a higher risk for blood clots. Condoms, coitus interruptus, and spermicidals can be used at no risk.

A client has been following the conventional 28-day regimen for contraception. She is now considering switching to an extended oral contraceptive (OC) regimen. She is seeking information about specific safety precautions. Which is true for the extended OC regimen? It is not as effective as the conventional regimen. It prevents pregnancy for 3 months at a time. It carries the same safety profile as the 28-day regimen. It does not ensure restoration of fertility if discontinued.

Recent studies have shown that the extended use of active OC pills carries the same safety profile as the conventional 28-day regimen. This option helps reduce the number of periods and is as effective as the conventional regimen. There is no evidence to suggest that discontinuation of active OCs will not ensure restoration of fertility. Medroxyprogesterone, not active OC pills, prevents pregnancy for 3 months at a time.

A client in her second trimester of pregnancy asks the nurse for information regarding certain oral medications to induce a miscarriage. What information should this client be given about such medications? They are available only in the form of suppositories. They can be taken only in the first trimester. They present a high risk of respiratory failure. They are considered a permanent end to fertility.

The client is seeking a medical abortion. The nurse should inform the client that such medications are effectively used to terminate a pregnancy only during the first trimester, not the second. The medications are available as a vaginal suppository or in oral form and do not present a high risk of respiratory failure. Sterilization, not abortion, is considered a permanent end to fertility.

The school nurse is preparing a health education session on the topic of birth control for a college group. Which method should the nurse emphasize for this group? barrier hormonal rhythm transdermal

The nurse should emphasize a barrier method of birth control such as a condom. The condom will help not only with birth control but with the spread of STIs, which is common in this age group. The other methods, such as hormonal, rhythm, and transdermal, will only prevent pregnancy and are more commonly utilized in long-term monogamous relationships.

Progestin-only pills

contraceptive pills that contain a small dose of progestin and no estrogen. These OCs work primarily by thickening the cervical mucus to prevent penetration of the sperm and make the endometrium unfavorable for implantation. Progestin-only pills must be taken at a certain time every 24 hours. Breakthrough bleeding and a higher risk of pregnancy have made these OCs less popular than combination OCs

Risk factors for infertility in women include:

Overweight or underweight (can disrupt hormone function) Hormonal imbalances leading to irregular ovulation Uterine fibroids Tubal blockages Cervical stenosis Reduced oocyte quality Chromosomal abnormalities Congenital anomalies of the uterus Immune system disorders Chronic illnesses such as diabetes, thyroid disease, asthma STIs Ectopic pregnancy Age older than 27 Endometriosis Turner syndrome Eating disorders History of PID Smoking and alcohol consumption Multiple miscarriages Menstrual abnormalities Exposure to chemotherapeutic agents Psychological stress

benefits of OC

Reduced incidence of ovarian and endometrial cancer Prevention and treatment of endometriosis Decreased incidence of acne and hirsutism Decreased incidence of ectopic pregnancy Decreased incidence of acute PID and possible protection against PID Reduced incidence of fibrocystic breast disease Decreased perimenopausal symptoms Reduced risk of developing uterine fibroids Maintenance of bone mineral density (BMD) Improvement in asthmatic symptoms Delayed onset of multiple sclerosis and arthritis Increased menstrual cycle regularity Lower incidence of colorectal cancer Decreased number of pregnancy-related deaths by preventing pregnancy Reduced iron-deficiency anemia by treating menorrhagia Reduced incidence of dysmenorrhea

A woman visits the family planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her? She is 30 years old. She has irregular menstrual cycles. She has a history of allergy to foreign protein. She has a family history of thromboembolism.

The estrogen content of birth control pills may lead to increased blood clotting, leading to an increased incidence of thromboembolism. Women who already are prone to this should not increase their risk further.

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend? transdermal contraception female condom cervical cap diaphragm

The fact that this woman has a latex allergy rules out the female condom, cervical cap, and diaphragm. Moreover the diaphragm is contraindicated in her case, due to her papillomavirus infection. The best choice for her is the transdermal contraception, which involves wearing a patch for a week at a time and does not require taking pills daily.

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." "The least costly method would be a surgical procedure to determine if your fallopian tubes are blocked." "The least costly method would be to purchase a commercial kit from the store to assess the upsurge of LH that occurs just after ovulation." "The least costly method would be to purchase an at-home testing kit for sperm motility."

The least costly way to determine a woman's ovulation pattern is to ask her to record her basal body temperature (BBT) for at least 4 months

The nurse is assessing a young couple who desire to get pregnant. The 38-year-old husband and 29-year-old wife report they had used COC; however, they have now been trying unsuccessfully to conceive over the past 4 months. What is the best response for the nurse to make? Return in 9 months for further assessment if not pregnant. Should seek fertility counseling from a specialist. Increase intercourse frequency to four times a week around the time of ovulation. Should undergo comprehensive diagnostic testing.

The most fertile time is the ovulation period of the woman's ovarian cycle. Increasing the frequency of intercourse around ovulation will increase the chance of conception. Individuals are not considered infertile until they have tried for at least 1 year to get pregnant. If this couple is still not pregnant after 8 months, then they can be referred for a fertility workup.

A nurse is preparing a presentation for a health fair on the topic of vasectomy. Which information should the nurse point out in the information? Relatively easy procedure with few complications Regular sperm counts are not essential Procedure is effective immediately Birth control measures are not required

The nurse should inform the individuals that vasectomy is a relatively easy procedure with few complications. Regular sperm counts following a vasectomy are important, as it will take approximately a month for the remaining sperm to exit the body. The client should use birth control measures until his sperm count remains at zero for 6 weeks.

A couple is being assessed for infertility. The male partner is required to collect a semen sample for analysis. What instruction should the nurse give him? Abstain from sexual activity for 10 hours before collecting the sample. Avoid strenuous activity for 24 hours before collecting the sample. Collect a specimen by ejaculating into a condom or plastic bag. Deliver sample for analysis within 1 to 2 hours after ejaculation.

The nurse should instruct the client to deliver the semen sample to the laboratory for analysis within 1 to 2 hours after ejaculation. The client should also be instructed to collect the sample in a specimen container, not a condom or plastic bag. The client needs to abstain from sexual activity for at least 24 hours before giving the sample, but he need not avoid strenuous activity.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation? an ovulation suppressant a spermicidal suppository the rhythm (calendar) method a diaphragm and spermicide

Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated.