Infertility

A client is to have a hysterosalpingogram. In this procedure, the physician will be able to determine which of the following? A. Whether or not the ovaries are maturing properly B. If the endometrium is fully vascularized C. If the cervix is incompetent D. Whether or not the fallopian tubes are obstructed

D The primary goal of a hysterosalpingogram is to learn whether or not the fallopian tubes are patent.

A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply) A. Anger at others who have babies B. Feeling of failure because they can't make a baby C. Sexual excitement because they want so desperately to conceive a baby D. Sadness because of the perceived loss of being a parent E. Guilt on the part of one partner because he or she is not able to give the other a baby

1,2,4,5 - Infertility clients often express anger at others who are able to conceive. - Infertility clients often express a feeling of personal failure. - Sadness is another common feeling expressed by infertility clients. - Guilt is commonly expressed by infertility clients.

A client is receiving Pergonal (menotropins) intramuscularly for ovarian stimulation. Which of the following is a common side effect of this therapy? A. Piercing rectal pain B. Mood swings C. Visual disturbances D. Jerky tremors

B Mood swings and depression are common side effects of the hormonal therapy.

The nurse is providing counseling to a group of sexually active single women. Most of the women have expressed a desire to have children in the future but not within the next few years. Which of the following actions should the nurse suggest the women take to protect their fertility for the future? (Select all that apply) A. Use condoms during intercourse B. Refrain from smoking cigarettes C. Maintain an appropriate weight for height D. Exercise in moderation E. Refrain from drinking carbonated beverages

1,2,3,4 - Condoms should be worn during sexual contacts to prevent infection with a sexually transmitted disease, which can affect the long-term health of the woman's reproductive system. - Women who smoke have a higher incidence of infertility than those who do not smoke. - Women who are either overweight or underweight have increased incidence of infertility. - Body mass index (BMI) is related to the amount of exercise a woman engages in. Those who exercise excessively are more likely to have a very low BMI and those who rarely exercise, to be obese. Since fertility is related to body weight, it is recommended that women exercise in moderation.

A nurse is teaching an infertile couple about how the sperm travel through the man's body during ejaculation. Please put the following five major structures in order, beginning with the place where spermatogenesis occurs and continuing through the path that the sperm and semen travel until ejaculation. 1. Epididymis 2. Prostate 3. Testes 4. Urethra 5. Vas deferens

3,1,5,2,4 The sperm are produced in the testes (3). They then proceed to the epididymis (1) where they mature. The vas deferens (5) is the conduit through which the sperm first travel during ejaculation. The prostate (2), encircling the neck of the urethra, produces a fluid that protects the sperm, and, finally, the sperm exit the male body via the urethra (4).

An infertility specialist is evaluating whether a woman's cervical mucus contains enough estrogen to support sperm motility. Which of the following tests is the physician conducting? A. Ferning capacity B. Basal body temperature C. Colposcopy D. Hysterotomy

A When a woman's cervical mucus is estrogen rich, it is slippery and elastic (thread-like), and when assessed under a microscope, the practitioner will observe "ferning" - that is, an image that looks like a fern. The woman is not in her fertile period, the mucus is thick and gluey.

The client who is infertile and diagnosed with endometriosis is prescribed leuprolide (Lupron), a GnRH medication. Which information should the nurse discuss with the client? (Select all that apply) A. Explain that this medication may take 3-6 months to work. B. Discuss that this medication will help regulate the client's menstrual cycle. C. Instruct to take the Lupron every night to help decrease menstrual pain. D. Teach that this medication will not affect when the client has intercourse. E. Tell the client not to drink grapefruit juice when taking this medication.

A,D - The client should be aware that it may take 3-6 months for leuprolide therapy to achieve maximum benefits; therefore, the nurse should discuss the long-term possibility with the client. - This medication does not affect when the client can have intercourse.

A nurse is educating a client who has been diagnosed with infertility on how to complete a basal body temperature chart to determine her ovulation pattern. The client states, "I really don't want to take my temperature every day. Is there any other way to find out if and when I ovulate?" A. "There are a number of other ways to determine ovulation, but they all require you to be examined by an obstetrician every month." B. "A test you can do at home requires you to spit on a microscopic slide and then look at the slide under a microscope." C. "You can test your vaginal discharge each day to determine when you should have intercourse because the hormone progesterone is elevated." D. "Although there are some tests that you can perform at home, they all cost well over a hundred dollars to purchase."

B This statement is correct. One of the at-home ovulation predictor kits requires women to place saliva on a microscopic slide and, after allowing the saliva to dry, to look at the slide under a microscope. If ovulation is occurring, the saliva appears ferned, that is, the image on the slide looks like the leaflets of a fern. The test detects the presence of high levels of estrogen in the woman's saliva.

The male client who is infertile asks the clinic nurse, "Is there anything I can take to increase my chances of fathering a child?" Which statement is the nurse's best response? A. "I am sorry, but there are no medications to help men with infertility." B. "Are you concerned about not being able to father a child?" C. "Testosterone therapy may help increase your sperm count." D. "You can take Clomid and it will help your partner get pregnant."

C Administration of testosterone will improve hormonal levels, resulting in a potential for increased spermatogenesis.

A client is to undergo a postcoital test for infertility. The nurse should include which of the following statements in the client's preprocedure counseling? A. "You will have the test the day after your menstruation ends." B. "You will have a dye put into your vein that will show up on x-ray." C. "You should refrain from having intercourse for the four days immediately before the test." D. "You should experience the same sensations you feel when your doctor does your Pap test."

D The client will undergo a speculum examination when cervical mucus will be harvested.

Infertility increases a client's risk of which of the following diseases? A. Diabetes mellitus B. Nystagmus C. Cholecystitis D. Ovarian cancer

D Infertility has been shown to increase a woman's risk of developing ovarian cancer.

The nurse is preparing a client for in vitro fertilization (IVF). Which statement best describes the scientific rationale for administering supplemental progesterone to this client? A. To enhance the receptivity of the endometrium to implantation. B. To provide more hormone to the ovary for egg production. C. To help regulate the client's monthly menstrual cycle. D. To decrease galactorrhea in the client if fertilization occurs.

A Progesterone enhances the receptivity of the endometrium to implantation - the function of progesterone in the body - and is the scientific rationale for administering supplemental progesterone to a client preparing fro in vitro fertilization.

A couple is seeking infertility counseling. The practitioner has identified the factors listed below in the woman's health history. Which of these findings may be contributing to the couple's infertility? A. The client is 36 years old B. The client was 13 years old when she started to menstruate C. The client works as a dental hygienist 3 days a week D. The client jogs 2 miles every day

A The eggs of an older woman (for reproductive purposes considered age 35 years +) age and fertility is reduced.

A client asks the nurse about the gamete intrafallopian transfer (GIFT) procedure. Which of the following responses would be appropriate for the nurse to make? A. Fertilization takes place in the woman's body B. Zygotes are placed in the fallopian tubes C. Donor sperm are placed in a medium with donor eggs D. A surrogate carries the infertile woman's fetus

A This statement is true. Although the gametes are placed in the fallopian tubes artificially, fertilization does occur within the woman's body.

The nurse is discussing fertility issues. Which statement indicates the couple is knowledgeable of fertility issues? A. "My insurance should cover the cost of the medications completely." B. "A multifetal pregnancy can result in preterm labor and birth." C. "There is an excellent probability we will get pregnant the first time." D. "Most of the implanted zygotes will result in a live birth."

B Pregnancy with more than twins carries a substantially higher risk to the mother and the fetuses because of preterm labor and birth, placental insufficiency, and high demand on maternal body systems.

The client experiencing infertility is prescribed bromocriptine (Parlodel). The client calls the clinic nurse and reports that she thinks she may be pregnant. Which intervention should the clinic nurse implement first? A. Schedule the client for a pelvic sonogram. B. Instruct the client to quit taking the medication. C. Tell the client to make an appointment with the HCP. D. Encourage the client to confirm with a home pregnancy test.

B The client must quit taking the medication immediately because it can cause a miscarriage of the fetus. Once the client becomes pregnant, the medication is not needed anymore.

A client who is undergoing ovarian stimulation for infertility calls the infertility nurse and states, "My abdomen feels very bloated, my clothes are very tight, and my urine is very dark." Which of the following is the appropriate statement for the nurse to make at this time? A. "Please take a urine sample to the lab so they can check it for an infection." B. "Those changes indicate that you are likely already pregnant." C. "It is important for you to come into the office to be examined today." D. "Abdominal bloating is an expected response to the medications."

C This client should be seen by her infertility doctor.

The female client has been taking infertility medications. Which signs or symptoms indicate ovarian overstimulation syndrome? A. Abdominal bloating and vague gastrointestinal discomfort. B. Bright-red vaginal bleeding with golf ball-size clots. C. A positive fluid wave and lower abdominal wave. D. Burning and an increased frequency of urinating.

C Ovarian hyperstimulation syndrome involves marked ovarian enlargement with exudation of fluid into the woman's peritoneal and pleural cavities. This syndrome can result in ovarian cysts that may rupture, causing pain.

A couple has been told that the male partner, who is healthy, is producing no sperm "because he has cystic fibrosis." Which of the following explanations is accurate in relation to this statement? A. Since the man is healthy, he could not possibly have cystic fibrosis B. Men with cystic fibrosis often have no epididymis C. The expressivity of cystic fibrosis is variable D. Cystic fibrosis is a respiratory illness having nothing to do with reproduction

C This statement is correct. Cystic fibrosis can be expressed in a number of ways. Some affected individuals have very serious illness resulting in early death, while others experience few symptoms.

A 35-year-old client is being seen for her yearly gynecological examination. She states that she and her partner have been trying to become pregnant for a little over 6 months and that a friend had recently advised her partner to take ginseng to improve the potency of his sperm. The woman states that they have decided to take their friend's advice. On which of the following information should the nurse base his or her reply? A. Based on their history, the client and her partner have made the appropriate decision regarding their fertility. B. Ginseng can cause permanent chromosomal mutations and should be stopped immediately. C. It is unnecessary to become concerned about this woman's fertility because she has tried to become pregnant for only a few months. D. Although ginseng may be helpful, it would be prudent to encourage the woman to seek fertility counseling.

D Because fertility drops as a woman ages, it is advisable to encourage the couple to use conventional therapies in conjunction with the complementary therapy to maximize their potential of becoming pregnant.

A client is hospitalized in the acute phase of severe ovarian hyperstimulation syndrome. The following nursing diagnosis has been identified: Fluid volume excess (extravascular) related to third spacing. Which of the following nursing goals is highest priority in relation to this diagnosis? A. Client's weight will be within normal limits by date of discharge B. Client's skin will show no evidence of breakdown throughout hospitalization C. Client's electrolyte levels will be within normal limits within one day D. Client's lung fields will remain clear throughout hospitalization

D This is the priority nursing goal related to ovarian hyperstimulation syndrome.

A female client seeks care at an infertility clinic. Which of the following tests may the client undergo to determine what, if any, infertility problem she may have? (Select all that apply) A. Chorionic villus sampling B. Endometrial biopsy C. Hysterosalpingogram D. Serum progesterone assay E. Postcoital test

2,3,4,5 - Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. - Hysterosalpingogram is performed after menstruation to detect whether or not the fallopian tubes are patent. - Serum progesterone assay is performed about 1 week following ovulation to determine whether or not the woman's corpus luteum produces enough progesterone to sustain a pregnancy. - Postcoital tests are performed about 1 to 2 days before ovulation to determine whether healthy sperm are able to survive in the cervical mucus.

A couple is seeking advice regarding actions that they can take to increase their potential of becoming pregnant. Which of the following recommendations should the nurse give to the couple? A. The couple should use vaginal lubricants during intercourse B. The couple should delay having intercourse until the day of ovulation C. The woman should refrain from douching D. The man should be on top during intercourse

C The woman should refrain from douching. Douching can change the normal flora and the pH in the vagina, making the environment hostile to the sperm.

The male client experiencing infertility problems tells the clinic nurse that he is taking St. John's wort for his depression. Which statement is the nurse's best response? A. "This herb is useful for depression. I hope it will help." B. "Did you discuss taking this herb with your psychologist?" C. "This herb may cause more infertility problems." D. "Is your significant other taking any herbal medication?"

C St. John's wort may cause effects on sperm cells, decreased sperm motility, and decreased viability; therefore, this client should not take this herb.

A couple is seeking infertility counseling. During the history, it is noted that the man is a cancer survivor, drinks one beer every night with dinner, and takes a sauna every day after work. The response provided by the nurse should be based on which of the following? A. It is unlikely that any of these factors is affecting his fertility. B. Daily alcohol consumption could be altering his sperm count. C. Sperm may be malformed when exposed to the heat of the sauna. D. Cancer survivors have the same fertility rates as healthy males.

C The high temperature of the sauna could alter the number and morphology of the sperm.

A client has been notified that because of fallopian tube obstruction, her best option for becoming pregnant is through in-vitro fertilization. The client asks the nurse about the procedure. Which of the following responses is correct? A. "During the stimulation phase of the procedure, the physician will make sure that only one egg reaches maturation." B. "Preimplantation genetic diagnosis will be performed on your partner's sperm before they are mixed with your eggs." C. "After ovarian stimulation, you will be artificially inseminated with your partner's sperm." D. "Any extra embryos will be preserved for you if you wish to conceive again in the future."

D This response is correct. Since multiple embryos are usually created during the in-vitro process, there are often more embryos created than are implanted. The couple may preserve the embryos.

A client is to have a hysterosalpingogram. Which of the following information should the nurse provide to the client prior to the procedure? A. "The test will be performed through a small incision next to your belly button." B. "You will be on bedrest for a full day following the procedure." C. "An antibiotic fluid will be instilled through a tube in your cervix." D. "You will be asked to move from side to side so that x-ray pictures can be taken."

D This statement is correct. A number of pictures will be taken throughout the procedure. The client, who will be awake, is asked to move into positions for the x-rays.

A nurse working in an infertility clinic should include which of the following in her discussions with the couple? A. Adoption as an alternative to infertility treatments B. The legal controversy surrounding intrauterine insemination C. The need to seek marriage counseling before undergoing infertility treatments D. Statistics regarding the number of couple who never learn why they are infertile

A It is important for the couple to be provided with al relevant information. Adoption is a viable alternative to infertility treatments.

An infertile man is being treated with Viagra (sildenafil citrate) for erectile dysfunction (ED). Which of the following is a contraindication for this medication? A. Preexisting diagnosis of herpes simplex 2 B. Nitroglycerin ingestion for angina pectoris C. Retinal damage from type I diabetes mellitus D. Complications after resection of the prostate

B It is unsafe to take Viagra while also taking nitroglycerin for angina.

A client is to receive Pergonal (menotropins) injections for infertility prior to in-vitro fertilization. Which of the following is the expected action of this medication? A. Prolongation of the luteal phase B. Stimulation of ovulation C. Suppression of menstruation D. Promotion of cervical mucus production

B Pergonal is administered to infertile women to increase follicular growth and maturation of the follicles and to stimulate ovulation.

The client experiencing infertility is receiving menotropin (Pergonal), an ovarian stimulant, and human chorionic gonadotropin. Which diagnostic test indicates the medications are effective? A. A serum human chorionic gonadotropin level. B. A serum estrogen level. C. A negative urine pregnancy test. D. A hemoglobin A1c.

B The serum estrogen level should increase three to four times the pretreatment baseline if the medications are effective and the client may be able to get pregnant.

A Roman Catholic couple is infertile. Their healthcare practitioner advises them that their best chance of getting pregnant is via in-vitro fertilization with a mixture of the man's sperm and donor sperm. Which of the following issues, related to this procedure, should the nurse realize may be in conflict with the couple's religious beliefs? (Select all that apply) A. The man will ejaculate by masturbation into a specially designed condom. B. The woman may become pregnant with donor sperm. C. Fertilization is occurring in the artificial environment of the laboratory. D. More embryos may be created than will be used to inseminate the woman. E. The woman will receive medications to facilitate the ripening of her ova.

1,2,3,4 - Masturbation and the use of a condom, even for the express purpose of creating life, are considered sins in the Catholic tradition. - Procreation with the man's sperm alone is unlikely. The addition of the donor sperm makes this unacceptable in the eyes of the Catholic Church because a woman should become pregnant only by her husband. - According to the precepts of the Catholic Church, fertilization may take place only within the body of the woman. - It is immoral in the Catholic tradition to create more embryos than are needed to conceive.

Nurses working in a midwifery office have attended a conference to learn about factors that increase a woman's risk of becoming infertile. To evaluate the nurses' learning, the conference coordinator tests the nurses' knowledge at the conclusion of the seminar. Which of the following problems should the nurses state increase a client's risk of developing infertility problems? (Select all that apply) A. Women who have menstrual cycles that are up to 30 days long B. Women who experience pain during intercourse C. Women who have had pelvic inflammatory disease D. Women who have excess facial hair E. Women who have menstrual periods that are over 5 days long

2,3,4 - Dyspareunia, or pain during intercourse, may be a symptom of a sexually transmitted infection (STI) or of endometriosis. Both STIs or of endometriosis can adversely affect a woman's fertility. - A woman who has had pelvic inflammatory disease (PID) is much more likely to have blocked fallopian tubes than a woman who has never had PID. - Women who have facial hair (hirsutism) often have polycystic ovarian syndrome (PCOS). PCOS patients frequently have irregular menses, elevated serum cholesterol, and insulin resistance. Women with PCOS are often infertile.

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? A. The couple has established a set schedule for their sexual encounters B. The couple has been married for more than eight years C. The couple lives with one set of parents D. The couple has close friends who gave birth to a baby within the past year

A Clients who "schedule" intercourse often complain that their sexual relationship is unsatisfying.

An infertile woman has been diagnosed with endometriosis. She asks the nurse why that diagnosis has made her infertile. Which of the following explanations is appropriate for the nurse to make? A. "Scarring surrounds the ends of your tubes, preventing your eggs from being fertilized by your partner's sperm." B. "You are producing insufficient quantities of follicle-stimulating hormone that is needed to mature an egg every month." C. "Inside your uterus is a benign tumor that makes it impossible for the fertilized egg to implant." D. "You have a chronic infection of the vaginal tract that makes the secretions hostile to your partner's sperm."

A Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The tissue may be on, for example, the tubes, ovaries, or colon. Adhesions develop from the monthly bleeding at the site of the misplaced endometrial tissue, often resulting in infertility.

A couple who has sought fertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occurs? A. The testes are overheated B. The vas deferens is ligated C. The prostate gland is enlarged D. The flagella are segmented

A Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm.

Which instruction by the nurse should be included in the teaching plan for an infertile woman who has been shown to have a 28-day biphasic menstrual cycle? A. Douche with a cider vinegar solution immediately before having intercourse B. Schedule intercourse every day from day 8 to day 14 of the menstrual cycle C. Be placed on follicle-stimulating hormone therapy by the fertility specialist D. Assess the basal body temperature pattern for at least 6 more months

B This action is recommended. Pregnancy is most likely to occur with daily intercourse from 6 days before ovulation up to the day of ovulation.

The female client is taking clomiphene (Clomid), an estrogen antagonist. Which statement indicates the client understands the risk of taking this medication? A. "The medication may cause my child to have Down syndrome." B. "There are very few risks associated with taking this medication." C. "I should stagger the times that I take this medication." D. "This medication may increase my chance of having twins."

D Clomid is an ovarian stimulant that promotes follicle maturation and ovulation. Many follicles can mature simultaneously, resulting in the increased possibility of multiple births.

An Orthodox Jewish couple is seeking infertility counseling. The woman states that her menstrual cycle is 21 days long. After testing, no physical explanation is found for the infertility. Which of the following may explain why the woman has been unable to conceive? A. Her kosher diet is lacking the essential nutrients needed for achieving optimal reproductive health. B. The positions allowed Orthodox Jewish couples during intercourse hinder the process of fertilization C. Orthodox Jewish couples are known to have a high rate of infertility because of inborn genetic diseases D. Orthodox Jewish couples refrain from intercourse during menses and for seven days after it ends

D Jewish law does prohibit intercourse during the menses and for 7 days following menses. The woman then goes through a cleansing bath called a mikvah before she and her husband may have intercourse. With such a short cycle, she is ovulating during the time frame in which intercourse is restricted.

The nurse administers human chorionic gonadotropin (HCG) intramuscularly to the female client who is infertile. Which instruction should the nurse discuss with the couple regarding coitus? A. Explain the need to abstain from sexual intercourse for 14 days after receiving the medication. B. Instruct the male partner to wear boxer shorts while his female partner is taking human chorionic gonadotropin. C. Discuss taking the basal metabolic temperature and having sexual intercourse when it becomes elevated 2 degrees. D. Advise the couple to have intercourse on the eve of receiving medication and 3 days after receiving medication.

D The couple should have sexual intercourse during this time because this is the probable period of ovulation.