OB Quiz

46. Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include (Select all that apply): a. Fellatio. b. Unprotected anal intercourse. c. Multiple sex partners. d. Dry kissing. e. Abstinence.

A, B, C

***A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests and we will know what is wrong." What is the nurse's best response? "I know the test will identify what is wrong." "I'm sure that once you finish these tests, your problem will be resolved." "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." "After you've identified your problem, you may want to look at the option of adoption."

Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts. (C)

43. The drug of choice for treatment of gonorrhea is: a. Penicillin G. b. Tetracycline. c. Ceftriaxone. d. Acyclovir.

c. Ceftriaxone.

15. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: a. Acetaminophen. b. Oral contraceptives (OCPs). c. Nonsteroidal antiinflammatory drugs (NSAIDs). d. Aspirin.

c. Nonsteroidal antiinflammatory drugs (NSAIDs).

35. After a mastectomy a woman should be instructed to perform all of the following except: a. Emptying surgical drains twice a day and as needed. b. Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon. c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side. d. Reporting immediately if inflammation develops at the incision site or in the affected arm.

c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side.

16. The two primary areas of risk for sexually transmitted infections (STIs) are: a. Sexual orientation and socioeconomic status. b. Age and educational level. c. Large number of sexual partners and race. d. Risky sexual behaviors and inadequate preventive health behaviors.

d. Risky sexual behaviors and inadequate preventive health behaviors.

30. The nurse who is teaching a group of women about breast cancer would tell the women that: a. Risk factors identify more than 50% of women who will develop breast cancer. b. Nearly 90% of lumps found by women are malignant. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown.

d. The exact cause of breast cancer is unknown.

2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

d. Using a heating pad on the abdomen to relieve cramping

Which method is used to determine the presence of varicoceles in the testes? Semen analysis Scrotal ultrasound Transrectal ultrasound Sperm penetration assay

A scrotal ultrasound is used to examine the testes for the presence of varicoceles. It is also used to identify abnormalities in the scrotum and/or the spermatic cord. Semen analysis is used to detect the ability of the sperm to fertilize an egg. Transrectal ultrasound is used to evaluate the ejaculatory ducts, seminal vesicles, and vas deferens. Sperm penetration assay is used to evaluate the ability of the sperm to penetrate an egg. (B)

45. There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including (Select all that apply): a. Regular exercise. b. Improved nutrition. c. A daily glass of wine. d. Smoking cessation. e. Oil of evening primrose.

A, B, D, E

47. The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors (Select all that apply)? a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

A, D, E

The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.) a."It is highly unlikely that you will become pregnant after the procedure." b."Tubal ligation is an effective form of 100% permanent sterilization. You won't be able to get pregnant." c."Sterilization offers some form of protection against STIs." d."Sterilization offers no protection against STIs." e."Your menstrual cycle will greatly increase after your sterilization."

ANS: A, D A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation.

Which medication can be prescribed for a client with excessive prolactin levels? Clomiphene (Clomid) Bromocriptine (Parlodel) Leuprolide acetate (Lupron) Ganirelix acetate (Antagon)

Increased prolactin levels cause anovulation. Therefore, bromocriptine (Parlodel) must be prescribed to reduce excessive prolactin levels. Clomiphene (Clomid) is prescribed for ovulation induction and for the treatment of luteal phase inadequacy. Leuprolide acetate (Lupron) is prescribed for the treatment of uterine fibroids. Ganirelix acetate (Antagon) is prescribed for infertility treatment. (B)

The nurse is teaching about infertility. A student nurse asks about the viability of sperm in the female reproductive tract. Which statement made by the nurse is accurate? The sperm remain viable for about 24 hours in the female reproductive system. The sperm remain viable for about 48 hours in the female reproductive system. The sperm remain viable for about 72 hours in the female reproductive system. The sperm remain viable for about 96 hours in the female reproductive system.

Sperm remain viable in the female reproductive tract for 48 hours. However, most of them remain potent for 24 hours. The sperm will degenerate after 48 hours and are eliminated from the female reproductive tract. Because the sperm contain food reserves for only 48 hours, they cannot be viable after 72 or 96 hours. (B)

A male client has been diagnosed with subfertility. Which instructions by the nurse are the most appropriate? Select all that apply. "Include antioxidants in your diet." "Use lubricant during intercourse." "Take baths in hot water regularly." "Avoid keeping your cell phone on your belt." "Wear loose, comfortable pants."

Subfertile men should be advised to eat a diet rich in antioxidants like vitamins E and C. Cell phones placed at the belt or hip may decrease sperm quality and should be avoided. Wearing loose, comfortable pants may improve sperm count. Hot baths and saunas create high scrotal temperatures, which decrease spermatogenesis. Therefore, hot baths should be avoided. Lubricants should not be used during intercourse, because they may diminish sperm motility and quality. (A,D,E)

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

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

A 25-year-old client complains that she has not had her period for 2 months following the discontinuation of oral contraceptives. What instruction does the nurse expect from the primary health care provider? Administer tricyclic antidepressants to the client. Suggest a diet rich in animal protein to the client. Administer phenothiazine (Compazine) to the client. Do not administer menstruation-inducing medication to the client for the next 4 months.

The client has been experiencing amenorrhea, or the absence of menstrual periods in women of reproductive age, which is common immediately following the discontinuation of oral contraceptives. Most women resume menstruation within 6 months of the discontinuation of oral contraceptives. Therefore, the primary health care provider would not consider prescribing any menstruation-inducing medication for another 4 months. Tricyclic antidepressants; are unrelated to a woman's menstrual cycle; hence, they should be avoided. A diet rich in animal protein is associated with early menopause, so it should be avoided. Phenothiazine (Compazine) should not be prescribed, because it may cause increased prolactin levels which may lead to amenorrhea. (D)

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

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

The nurse is caring for a client who is pregnant as a surrogate mother. Which condition would the biologic mother have to need to use a gestational surrogate? Ovarian failure Tubal blockage Early menopause Uterine myoma

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

What laboratory finding would indicate that the nurse should inform the client about egg donation? The follicle-stimulating hormone (FSH) level is high. The follicle-stimulating hormone (FSH) level is low. The progesterone level is low. The progesterone level is high.

The follicle-stimulating hormone (FSH) levels of the client would be assessed to determine ovarian reserves. If FSH levels are greater than 20, this indicates that a pregnancy will not occur with the client's own eggs. Therefore, the nurse should counsel the client regarding egg donation to achieve pregnancy. If FSH levels are 8, then it indicates that the client has adequate ovarian reserve and does not need egg donation. Progesterone levels do not have much effect on the production of ova, so the nurse need not inform the client about egg donation. (A)

What factors should the nurse assess in the client with anovoluation? Select all that apply. Endometriosis Vaginal infections Thyroid disorders Pituitary gland disorders Pancreatic gland disorders

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

4. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. b. PMS. c. Primary dysmenorrhea. d. Secondary dysmenorrhea.

a. Endometriosis.

20. A woman has a thick, white, lumpy, cottage cheese-like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir

a. Fluconazole

21. To detect human immunodeficiency virus (HIV), most laboratory tests focus on the: a. virus. b. HIV antibodies. c. CD4 counts. d. CD8 counts.

b. HIV antibodies.

26. The nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within: a. 6 to 10 days. b. 2 to 4 weeks. c. 6 to 8 weeks. d. 6 months.

c. 6 to 8 weeks.

42. Which patient is most at risk for fibroadenoma of the breast? a. A 38-year-old woman b. A 50-year-old woman c. A 16-year-old girl d. A 27-year-old woman

c. A 16-year-old girl

12. With regard to endometriosis, nurses should be aware that: a. It is characterized by the presence and growth of endometrial tissue inside the uterus. b. It is found more often in African-American women than in white or Asian women. c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. It is unlikely to affect sexual intercourse or fertility.

c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause.

5. Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug: a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. b. Should be sprayed into one nostril every other day. c. Should be injected into subcutaneous tissue BID. d. Can cause her to experience some hot flashes and vaginal dryness.

d. Can cause her to experience some hot flashes and vaginal dryness.

40. The nurse providing care in a women's health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia

d. Chlamydia

13. One of the alterations in cyclic bleeding that occurs between periods is called: a. Oligomenorrhea. b. Menorrhagia. c. Leiomyoma. d. Metrorrhagia.

d. Metrorrhagia.

24. The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: a. Acyclovir. b. Ofloxacin. c. Podophyllin. d. Zidovudine.

d. Zidovudine.

If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate? a.Spermicides b.Female condoms c.Male condoms d.Diaphragms

ANS: C For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates are approximately 28%. The failure rate for female condoms is approximately 21%. The failure rate for diaphragms with spermicides is 12%.

Which tests are used to identify tubal patency? Select all that apply. Urine predictor test Hysterosalpingogram Clomiphene citrate challenge test Hysterosalpingography Chlamydia immunoglobulin G antibodies

Hysterosalpingogram, hysterosalpingography, and chlamydia immunoglobulin G antibodies are used to identify tubal patency. The urine predictor test is used to detect the timing of lutein hormone surge before ovulation. The clomiphene citrate challenge test is used to check the level of follicle-stimulating hormone (FSH). (B,D,E)

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in what form? A. Intranasal spray B. Vaginal suppository C. Intramuscular injection D. Tablet

Urofollitropin is given by intramuscular injection; the dosage may vary. Intranasal spray is not the appropriate route for urofollitropin. Vaginal suppository is not the correct route for urofollitropin. Urofollitropin cannot be given by tablet; it is given only by IM injection. (C)

38. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely: a. Fibroadenoma. b. Lipoma. c. Intraductal papilloma. d. Mammary duct ectasia.

c. Intraductal papilloma.

7. When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: a. Stress. b. Excessive exercise. c. Pregnancy. d. Eating disorders.

c. Pregnancy.

32. A healthy 60-year-old African-American woman regularly receives her health care at the clinic in her neighborhood. She is due for a mammogram. At her previous clinic visit, her physician, concerned about the 3-week wait at the neighborhood clinic, made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What would be the most appropriate statement for the nurse to make to this patient? a. "Do you have transportation to the teaching hospital so that you can get your mammogram?" b. "I'm concerned that you missed your appointment; let me make another one for you." c. "It's very dangerous to skip your mammograms; your breasts need to be checked." d. "Would you like me to make an appointment for you to have your mammogram here?"

d. "Would you like me to make an appointment for you to have your mammogram here?"

36. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages.

d. A single lump in one breast that can be expected to shrink as the woman ages.

Which of the following could affect female fertility? Select all that apply. Partner relationship status Financial history A clinical diagnosis of anemia. Bicornate uterus Uterine abnormality Cephalopelvic disproportion (CPD)

A diagnosis of anemia can affect a woman's fertility status. The presence of a uterine abnormality can affect a woman's fertility status. The presence of CPD relates to whether or not a woman can successfully deliver a baby vaginally based on obtained pelvic measurements. Partner relationship status, although important to one's well-being, does not typically affect female fertility. Financial history is not a factor in determining female fertility. (C,D,E)

29. An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections and human immunodeficiency virus is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: a. Strategies to enhance condom use. b. Choice of colors and special features. c. Leaving the decision up to the male partner. d. Places to carry condoms safely.

a. Strategies to enhance condom use.

37. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? a. The blood pressure (BP) cuff should not be applied to the affected arm. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The affected arm should be held down close to the woman's side.

a. The blood pressure (BP) cuff should not be applied to the affected arm.

27. A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, "What is that? Can you get rid of it?" Your best response is: a. "It's just a little lump on your cervix. We can freeze it off." b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer." c. "HPV is a type of early human immunodeficiency virus (HIV). You will die from this." d. "You probably caught this from your current boyfriend. He should get tested for this."

b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer."

22. Care management of a woman diagnosed with acute pelvic inflammatory disease (PID) most likely would include: a. Oral antiviral therapy. b. Bed rest in a semi-Fowler position. c. Antibiotic regimen continued until symptoms subside. d. Frequent pelvic examination to monitor the progress of healing.

b. Bed rest in a semi-Fowler position.

9. During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: a. Amenorrhea. b. Dysmenorrhea. c. Dyspareunia. d. Premenstrual syndrome (PMS).

b. Dysmenorrhea.

28. Which of the following statements about the various forms of hepatitis is accurate? a. A vaccine exists for hepatitis C but not for hepatitis B. b. Hepatitis A is acquired by eating contaminated food or drinking polluted water. c. Hepatitis B is less contagious than human immunodeficiency virus (HIV). d. The incidence of hepatitis C is decreasing.

b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

18. The viral sexually transmitted infection (STI) that affects most people in the United States today is: a. Herpes simplex virus type 2 (HSV-2). b. Human papillomavirus (HPV). c. Human immunodeficiency virus (HIV). d. Cytomegalovirus (CMV).

b. Human papillomavirus (HPV).

19. The U.S. Centers for Disease Control and Prevention (CDC) recommends that HPV be treated with client-applied: a. Miconazole ointment. b. Topical podofilox 0.5% solution or gel. c. Penicillin given intramuscularly for two doses. d. Metronidazole by mouth.

b. Topical podofilox 0.5% solution or gel.

17. When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: a. Gonorrhea. b. Syphilis. c. Chlamydia. d. Candidiasis.

c. Chlamydia.

44. The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are: a. A disease of the milk ducts and glands in the breasts. b. A premalignant disorder characterized by lumps found in the breast tissue. c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles. d. Lumpiness accompanied by tenderness after menses.

c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles

8. A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that: a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy. b. Fibroids increase in size during the perimenopausal period. c. Menorrhagia is a common finding. d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.

c. Menorrhagia is a common finding.

11. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? a. Premenstrual dysphoric disorder (PMDD) is a milder form of premenstrual syndrome (PMS) and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of PMS have been well established.

c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms.

33. The nurse must watch for what common complications in a patient who has undergone a transverse rectus abdominis myocutaneous (TRAM) flap? a. Axillary edema and tissue necrosis b. Delayed wound healing and muscle contractions c. Delayed wound healing and axillary edema d. Delayed wound healing and hematoma

d. Delayed wound healing and hematoma

10. With regard to dysmenorrhea, nurses should be aware that: a. It is more common in older women. b. It is more common in leaner women who exercise strenuously. c. Symptoms can begin at any point in the ovulatory cycle. d. Pain usually occurs in the suprapubic area or lower abdomen.

d. Pain usually occurs in the suprapubic area or lower abdomen.

A client tested negative on a clomiphene citrate challenge test (CCCT). Which technique would be included in the treatment plan to assist reproduction in the client? Using donor sperm to inseminate the client Placing prepared sperm in the client's uterus at the time of ovulation Transferring retrieved oocytes into the uterine tube after fertilization Transferring embryos, formed by inseminating donated eggs, into the uterus

A clomiphene citrate challenge test (CCCT) is used to assess ovarian stimulation in the client. Negative results of a CCCT imply that the client has poor ovarian reserve. This indicates the need for donor eggs or oocytes. Therefore, the primary health care provider would suggest assisted reproductive technology (ART), in which embryos formed by inseminating donated eggs are transferred into the client's uterus. Placing prepared sperm in the uterus at ovulation is called intrauterine insemination. This method is used in cases of male subfertility, cervical factors, and vaginal factors. Injection of a selected sperm cell into the client's egg for fertilization is called intracytoplasmic sperm injection. It is indicated if the male partner is azoospermic or oligospermic, or if one of the partners has a genetic defect. Oocytes cannot be retrieved from a client who has poor or no ovarian reserve. Gamete intrafallopian transfer involves fertilizing retreived oocytes with washed motile sperm and transferring them into the uterine tube. (D)

The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the woman's cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

ANS: 6; 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

***Which of the following, if found in both the male and female of a couple, could present an issue with regard to the couple's fertility? Male and female are the same age, 35. Both partners have had children in their past marriage. History of endocrine problems. History of hypertension.

A history of endocrine problems should be investigated further, because it may have an effect on the couple's fertility. Age is a relative factor, and because the recorded age is 35, it does not in itself present a significant fertility factor unless there are additional factors. The fact that both the man and woman have already had children is a favorable sign of fertility. Although hypertension is a relevant clinical finding, it may not have a direct bearing on the couple's fertility. (C)

The nurse is caring for a client who is scheduled to undergo a hysterosalpingogram. What possible abnormalities can be detected through the procedure? Presence of infection Blockage in the fallopian tubes Decrease in ovarian reserve Abnormal endometrial tissue

A hysterosalpingogram is an x-ray film on which the uterus and fallopian tubes can be visualized for abnormalities. The procedure can help to determine if the fallopian tubes are blocked. Presence of infection cannot be assessed with a hysterosalpingogram. Abnormalities in endometrial tissue are found when endometrial tissue implants itself outside the uterus and is observed by doing an ultrasound. Diagnostic laparoscopy may be indicated for this condition. (B)

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

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

The nurse is assessing a client with menstrual cycle irregularity. While speaking with the client, the nurse learns the client is an athlete. What should the nurse suggest to the client to promote a regular menstrual cycle? Undergo aromatherapy treatments Increase intake of food and water Perform aerobic exercise regularly No strenuous exercise for 5 months

An athletic woman who exercises vigorously can develop irregular menstrual cycles. Therefore, the nurse should instruct the client to increase food and water intake. This would increase the client's body mass index and possibly restart regular menstrual cycles. Aromatherapy and aerobic exercises are nonpharmaceutical ways to improve pregnancy rates. These would not be immediate approaches for clients facing irregular menstrual cycles. The nurse should not suggest changing exercise regimens or discourage physical exercise. (B)

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male client regarding this test, the nurse would tell him to do what? Ejaculate into a sterile container Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days Transport specimen with container packed in ice Ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation

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

A client is diagnosed with polycystic ovaries following laparoscopy. The client is diagnosed to have anovulation. What strategies included in the treatment would help the client conceive? Select all that apply. Diet plan rich in antioxidants Herbal therapy of ginseng Thyroid-stimulating hormone (Synthroid) daily Clomiphene (Clomid) and metformin (Glucophage) Clomiphene (Clomid) and dexamethasone (Decadron)

Anovulation, excess androgenic hormones, and insulin resistance are the most common symptoms of polycystic ovarian syndrome. Clomiphene (Clomid) is a selective estrogen receptor modulator, which is used as an ovarian stimulant. Insulin sensitizers like metformin (Glucophage) and dexamethasone (Decadron) potentiate the effects of clomiphene (Clomid) when given to women with anovulation and polycystic ovarian syndrome. Antioxidants like vitamins E and C and herbal medications like ginseng are beneficial in cases of male infertility. Thyroid-stimulating hormone (Synthroid) is useful to treat hypothyroidism and is not associated with polycystic ovarian disease. (D,E)

A client is being treated for a defect in the luteal phase. The nurse instructs the patient to start taking a drug on the fifth day of menstruation and continue for the next 5 days. Which drug is prescribed for the patient? Progesterone (Camila) Clomiphene citrate (Clomid) Nafarelin acetate (Synarel) Metformin (Glucophage)

Clomiphene citrate (Clomid) is used to treat luteal phase defects and induce ovulation. This drug is administered on the fifth day of menstruation. The medication is continued for the next 5 days in order to induce ovulation. Progesterone (Camila), which is administered as a vaginal gel once per day, is used to increase the luteal phase of menstruation. If ovulation is induced by Camila, the drug is continued until after 10 to 12 weeks of pregnancy. Nafarelin acetate (Synarel) is a gonadotropin-releasing hormone (GnRH) agonist used to treat endometriosis and uterine fibroids. It is a nasal spray used for 6 months. Metformin (Glucophage) is an oral hypoglycemia agent and has no role in treatment of luteal phase defects. (B)

The nurse instructs a student nurse to administer depot medroxyprogesterone acetate (DMPA) to a client. What precaution should be taken by the student nurse to ensure safe administration of the drug? Do not: massage the site after the administration. administer the injection at the deltoid muscle. administer the injection subcutaneously. aspirate a blood return prior to the injection.

Depot medroxyprogesterone acetate (DMPA) should be absorbed in the body slowly. Therefore, the nurse should not massage the site of administration after administering DMPA to the client. Massaging the site can hasten the absorption of the drug and shorten the period of effectiveness of the drug. The nurse can administer the injection into the deltoid muscle , because it is a preferable site for injection. The nurse can administer the injection subcutaneously, because this route is acceptable for this injection. Most medications must be aspirated prior to injection. The only drugs that should not be aspirated are anticoagulants and insulin. (A)

A client diagnosed with endometriosis expresses the desire to conceive. Which reproductive therapy would help the client to conceive? Gestational carrier Assisted hatching technique Intrauterine insemination technique In vitro fertilization-embryo transfer

Endometriosis is inflammatory peritoneal damage caused by endometrial tissue that migrates from the uterus and implants on the pelvic organs or connective tissue. In vitro fertilization-embryo transfer (IVF-ET) is often indicated for endometriosis. Therefore, the primary health care provider would suggest IVF-ET. IVF-ET involves the implantation of a laboratory-developed embryo into the uterus. A client with endometriosis would not need a gestational carrie, because the uterus can still hold a fetus to term. Assisted hatching is used to improve the implantation rate in women with previously unsuccessful IVF attempts. Intrauterine insemination is an indication for male subfertility and cervical factors. (D)

The nurse is assessing a 36-year-old client who is planning for a second pregnancy. After reviewing the client's medical record, the nurse provides information about the egg donation process to the client. What would be the reason for providing this information to the client? The client suffers from reduced fecundity. The client has age-related infertility. The client has congenital disorders. The client has premature ovarian failure.

Estrogen levels are reduced in a 36-year-old patient. This causes age-related infertility due to reduced production of ova (eggs) from the ovaries. Because of this condition, the nurse can assist the patient by informing her about fertilization treatments like egg donation. Fecundity means the ability to reproduce. Because the client has already had a pregnancy, the client does not have reduced fecundity. If the client has congenital abnormalities, then the nurse could suggest surrogate motherhood or adoption. Premature ovarian failure is observed in women who are below 30, not 36-year-olds. (B)

The nurse is caring for a client who is taking ganirelix acetate (Antagon) to treat infertility. Which adverse effects associated with the use of ganirelix acetate may be found in this client? Select all that apply. Headaches Depression Nosebleeds Abdominal pain Vaginal bleeding

Ganirelix acetate (Antagon) is a gonadotropin-releasing hormone (GnRH) antagonist. It is used for the treatment of infertility and controls ovarian stimulation. It suppresses the release of gonadotropin, which in turn affects prostaglandin levels. Due to this effect, the drug may cause adverse effects like headaches, abdominal pain, and vaginal bleeding. Depression is an adverse effect of human chorionic gonadotropin. Nosebleeds are an adverse effect of nafarelin acetate (Synarel). Therefore, depression and nosebleeds are not associated with ganirelix acetate (Antagon). (A,D,E)

A 37-year-old client says, "I haven't been able to conceive after trying for 3 months." Upon evaluating the client's medical history, the nurse finds that the client has a history of endometriosis. What does the nurse tell the client? "Continue trying for another 3 months and come back for an evaluation." "Continue trying for another 6 months and come back for an evaluation." "Continue trying for another 9 months and come back for an evaluation." "Continue trying for another year and come back for an evaluation."

Generally, a client is instructed to come for an evaluation after trying to conceive for one year. However, clients over the age of 35, or with risk factors such as endometriosis, are instructed to come for an evaluation after trying for 6 months. Because the client has already been trying to conceive for 3 months, the nurse should ask the client to come for evaluation after 3 additional months. The nurse should not instruct the client to undergo evaluation after 6 or 9 additional months, because it would be too long for a 35-year-old client. Clients under the age of 35 are asked to come for evaluation if they do not conceive after trying for one year. (A)

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." "Herbs have no bearing on fertility."

Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E promote fertility. Vitamin E, calcium, and magnesium may promote fertility and conception. (B)

***A nursing student is reviewing information relative to cultural beliefs about infertility. Which statement if made by a client would require intervention? "I want to consult my rabbi before going any further with an infertility work up." "I will not be able to use IVF therapies, because it is against my Roman Catholic religion as." "I have to take full responsibility for my failure to conceive." "I may consider having infertility treatments but I have to talk this over with my husband first."

In certain cultures, women are viewed as being responsible for all fertility problems; the fact that this statement acknowledges complete guilt would require the nursing student to intervene in order to provide compassion and decrease psychologic stress of the client. Individuals may want to discuss infertility treatments with their spiritual leaders regardless of which religion they are members of, and as such no intervention is required. Members of certain religions such as Roman Catholics may not be able to utilize IVF therapy as a result of their religious affiliation. "I may consider having infertility treatments but I have to talk this over with my husband first" is an expected statement, because both the female and male partner should discuss and explore available fertility options. (C)

Following a discussion about assisted reproductive therapy (ART), the nurse asks a student nurse questions about in vitro fertilization (IVF). Which statement by the student nurse indicates the need for further explanation? "IVF is commonly indicated for treating endometriosis." "In IVF, the ova are fertilized with the sperm in the lab." "In IVF, the ova are aseptically removed from the ovaries." "The fertilized embryo is placed into the fallopian tube."

In the IVF process, the embryo is not transferred into the fallopian tubes but directly placed in the endometrial lining of the uterus. IVF is indicated in females with endometriosis or tubal blockage. The eggs, aseptically collected from the ovaries, are fertilized with sperm under laboratory conditions until the embryo is formed. The embryo is then transferred into the uterus for further development. (D)

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

In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partner's sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer involves placing the sperm and ova in the fallopian tube. (A)

A 25-year-old client has been unable to conceive after being diagnosed with chlamydia. What infertility treatment would help the client conceive? In vitro fertilization therapy (IVF) Menotropin (Pergonal) therapy Zygote intrafallopian transfer (ZIFT) Gamete intrafallopian transfer (GIFT)

Infection caused by Chlamydia causes tubal damage, resulting in impaired fertility. Because the client's fallopian tubes are damaged, in vitro fertilization (IVF) will be the most suitable infertility treatment option for the client. With in vitro fertilization (IVF), ova are removed surgically from the client, fertilized outside the uterus, and reintroduced into the uterus. This method uses a special tube, which passes through the cervix to the uterus, completely bypassing the fallopian tubes. Menotropin (Pergonal) therapy is suggested if the client is experiencing ovarian dysfunction. Zygote intrafallopian transfer involves introducing the in vitro-fertilized ovum into the uterine tube at the zygote stage. However, this may not be possible if the fallopian tubes are blocked. Gamete intrafallopian transfer is the transfer of ova into the client's fallopian tube for fertilization. Gamete intrafallopian transfer would be inappropriate in a client with blocked fallopian tubes. (A)

The nurse reviews the medical reports of a client and finds that the client has a low sperm count. What should the nurse understand about the client? The client has retrograde ejaculation. The client has azoospermia. The client has erectile dysfunction. The client has an attack of mumps.

Low sperm volume may occur when spermatic fluid is ejaculated backward into the bladder, which is referred to as retrograde ejaculation. Azoospermia refers to complete loss of sperm cell production. The client does not have azoospermia, because the scenario indicates a low sperm count. A low sperm count does not indicate erectile dysfunction. Mumps would result in permanent damage to the testes after adolescence, which results in complete loss of sperm cell production. (A)

***Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issues would need to be addressed by an infertile couple before treatment? Select all that apply. Risk of multiple gestation Whether or how to disclose the facts of conception to offspring Freezing embryos for later use Financial ability to cover the cost of treatment Stress management techniques and couple counseling

Multiple gestation is indeed a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or a surrogate mother. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer want the embryos at a future time. Stress management techniques and couple counseling should be addressed before treatment. Although the method of payment is important, obtaining this information is not the nurse's responsibility. It is also of note that 14 states have mandated some form of insurance to assist couples with coverage for infertility. (A,B,C,E)

***The nurse is assessing a 37-year-old client with secondary infertility. While reviewing the client's laboratory reports, the nurse finds that the patient has a reduced ovarian reserve. Which laboratory report would the nurse have reviewed? Thyroxine hormone levels Prolactin hormone levels Follicle-stimulating hormone levels Human chorionic gonadotropin levels

Ovarian reserve refers to the number of viable ova that remain in the ovaries. To assess the ovarian reserve of the client, the nurse should check the levels of follicle-stimulating hormones on the third day of menstruation. Thyroxine levels indicate the presence of thyroid dysfunction. Though prolactin levels also contribute to anovulation, the follicle-stimulating hormone (FSH) level is considered the primary assessment standard for determining ovarian reserve. Human chorionic gonadotropin hormone levels are used in determining if a client is pregnant, because they are elevated during pregnancy. (C)

A worried client says, "I had my first child two years ago, and I've been trying get pregnant again for the past six months." Which medical term does the nurse use to describe the client's condition? Sterility Primary infertility Idiopathic infertility Secondary infertility

Secondary infertility is infertility seen in any client who has ever had a pregnancy, regardless of the outcome of that pregnancy. Sterility is the inability of the client to conceive. Primary infertility is infertility seen in clients who have never been pregnant. Idiopathic infertility is unexplained infertility. (D)

A couple arrives for their first appointment at an infertility center. A noninvasive test done during initial diagnostic testing is called what? Hysterosalpingogram Endometrial biopsy Semen analysis Laparoscopy

Semen analysis is the basic test for male infertility. Radiographic film examination allows visualization of the uterine cavity after instillation of radiopaque contrast medium through the cervix. The endometrial biopsy is an invasive procedure. A small cannula is introduced into the uterus and a portion of the endometrium is removed for histologic examination. Laparoscopy is useful in order to view the pelvic structures intraperitoneally. This is an invasive procedure. (C)

The nurse is teaching the nursing student about semen analysis. Which statement by the student indicates the need for further teaching? "The client should be instructed to masturbate to obtain the semen sample." "A cold environment or low temperature is suitable for storing the semen sample." "The test must be performed within 2 hours of collecting the semen sample." "A spermicide-free plastic sheath must be used to collect the semen sample."

Semen samples should not be kept in a cold environment or at low temperatures, because it reduces the sperm motility. For collecting the semen sample, the patient should be instructed to masturbate, because it stimulates the impulse. For an accurate estimation of sperm count, the test should be performed within 2 hours after collecting the semen sample. This helps to prevent deterioration of the sample. To keep the sperm alive, semen samples should be collected in plastic sheaths that are free from any spermicidal agent. (B)

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

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

A client is diagnosed with adhesions in the uterine lining. Which assisted reproductive therapy may be beneficial to the client? Assisted hatching technique Use of a surrogate mother Gamete intrafallopian transfer In vitro fertilization-embryo transfer

Surrogate motherhood is a process by which a woman is inseminated with semen from an infertile woman's husband and then carries the fetus until birth. This method is suggested for a patient with uterine adhesions who cannot become a gestational carrier (embryo host) due to an impaired uterus. Assisted hatching is used to improve the implantation rate in women with previously unsuccessful in vitro fertilization (IFV) attempts. Gamete intrafallopian transfer is indicated for tubal disease or blockage, endometriosis, and severe male infertility. In gamete intrafallopian transfer, the retrieved oocytes are fertilized with washed motile sperms in a catheter, and are transferred into the uterine tube. IVF-ET is indicated for endometriosis. This method involves fertilizing the woman's egg with sperm in the laboratory and then transferring it to her uterus after normal embryo development. (B)

What is the significance of the clomiphene citrate challenge test (CCCT)? To assess if the fallopian tubes are open and patent To assess for the presence of uterine abnormalities To assess the amount of progesterone production To assess follicle-stimulating hormone (FSH) levels

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

The nurse is assessing a client who is planning to conceive. While reviewing the client's laboratory reports, the nurse notices a decrease in hypothalamic hormone levels. What should the nurse interpret from this? The client will not be able to successfully produce any ova. The client demonstrates impairment in fallopian factors. The client has an increased risk of fetal congenital anomalies. The client has a family history of fetal hemorrhagic disorders.

The hypothalamus secretes thyrotropin-releasing hormones, corticotrophin-releasing hormones, gonadotropin-releasing hormones, and growth hormones. Among these, gonadotropin-releasing hormones (GnRH) and thyrotropin-releasing hormones play an important role during pregnancy. The hormones stimulate the gonads to produce ova in females and sperm in males. Therefore, low hypothalamic hormones indicate that the formation of ova is affected in the patient. Impaired fallopian factors cannot be interpreted based on the low hypothalamic hormones, because they require further evaluation. Congenital anomalies and hemorrhagic disorders are caused by genetic abnormalities in the fetus. They are not influenced by maternal hormone levels. (A)

***A client who has undergone several failed attempts at in vitro fertilization discusses her feelings with the nurse. If the client says that her inability to conceive does not affect her worth as a human being, what behavioral characteristic is the client showing? Guilt Denial Depression Acceptance

When a client realizes that unworthiness and impaired fertility are unrelated, the client shows acceptance (resolution). Guilt may cause the client to express feelings of responsibility for having somehow caused the infertility. The client might say, "It can't happen to me!" if in denial. The client may express hopelessness or feelings of worthlessness if suffering from infertility-related depression. (D)

3. Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)? a. "I feel irritable and moody a week before my period is supposed to start." b. "I have lower abdominal pain beginning the third day of my menstrual period." c. "I have nausea and headaches after my period starts, and they last 2 to 3 days." d. "I have abdominal bloating and breast pain after a couple days of my period."

a. "I feel irritable and moody a week before my period is supposed to start."

23. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish white vaginal discharge with a "fishy" odor; complaint of pruritus. On the basis of these findings, the nurse suspects that this woman has: a. Bacterial vaginosis (BV). b. Candidiasis. c. Trichomoniasis. d. Gonorrhea.

a. Bacterial vaginosis (BV)

39. Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: a. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary.

a. Diuretic administration.

41. A benign breast condition that includes dilation and inflammation of the collecting ducts is called: a. Ductal ectasia. b. Intraductal papilloma. c. Chronic cystic disease. d. Fibroadenoma.

a. Ductal ectasia.

25. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus (HSV)-2 b. Human papillomavirus (HPV) c. Human immunodeficiency virus (HIV) d. Cytomegalovirus (CMV)

a. Herpes simplex virus (HSV)-2

31. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Fine-needle aspiration (FNA) d. CA 15.3

c. Fine-needle aspiration (FNA)

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the mostcommon technique used for the termination of a pregnancy in the second trimester? a.Dilation and evacuation (D&E) b.Methotrexate administration c.Prostaglandin administration d.Vacuum aspiration

ANS: A D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.

Which statement regarding emergency contraception is correct? a.Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b.Emergency contraception may be taken right after ovulation. c.Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d.Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse? a.Family planning b.Birth control c.Contraception d.Assisted reproductive therapy

ANS: A Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapyis one of several possible treatments for infertility.

A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process? a.Obtain a history of the woman's menstrual cycle lengths for the past 6 to 12 months. b.Determine the client's weight gain and loss pattern for the previous year. c.Examine skin pigmentation and hair texture for hormonal changes. d.Explore the client's previous experiences with conception control.

ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.

Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be mosthelpful in achieving this goal? a."You should always remove your diaphragm 6 to 8 hours after intercourse. Don't use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4° C, hypotension, and a rash." b."You should remove your diaphragm right after intercourse to prevent TSS." c."It's okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS." d."Make sure you don't leave your diaphragm in for longer than 24 hours, or you may get TSS."

ANS: A The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses.

Which nonpharmacologic contraceptive method has a failure rate of less than 25%? a.Standard days' variation b.Periodic abstinence c.Postovulation d.Coitus interruptus

ANS: A The standard days' variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.

The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) a.Gallbladder disease b.Myocardial infarction and stroke c.Hypotension d.Breast tenderness and fluid retention e.Dry skin and scalp

ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma.

Which contraceptive method best protects against STIs and the HIV? a.Periodic abstinence b.Barrier methods c.Hormonal methods d.Same protection with all methods

ANS: B Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV.

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse's best response? a."Oral contraceptives are a highly effective method, but they have some side effects." b."Your current medications will reduce the effectiveness of the pill." c."Oral contraceptives will reduce the effectiveness of your seizure medication." d."The pill is a good choice for a woman of your age and with your personal history."

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception? a.Obtain data about the frequency of coitus. b.Determine the woman's level of knowledge concerning contraception and her commitment to any particular method. c.Assess the woman's willingness to touch her genitals and cervical mucus. d.Evaluate the woman's contraceptive life plan.

ANS: B Determining the woman's level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partner's willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partner's objections. Assessing the woman's willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the client's plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? a."The IUD does not interfere with sex." b."The risk of pelvic inflammatory disease will be higher with the IUD." c."The IUD will protect you from sexually transmitted infections." d."Pregnancy rates are high with the IUD."

ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%.

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate? a."They're not very effective, and it is very likely that you'll get pregnant." b."FAMs can be effective for many couples; however, they require motivation." c."These methods have a few advantages and several health risks." d."You would be much safer going on the pill and not having to worry."

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the client's part.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate? a."The lubricant prevents vaginal irritation." b."Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions." c."The additional lubrication improves sex." d."Nonoxynol-9 improves penile sensitivity."

ANS: B Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.

The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception? a.LAM is effective until the infant is 9 months of age. b.This popular method of birth control works best if the mother is exclusively breastfeeding. c.Its typical failure rate is 5%. d.Feeding intervals should be 6 hours during the day.

ANS: B The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night.

Which benefit regarding FAMs makes it an appealing choice for some women? a.Adherence to strict recordkeeping b.Absence of chemicals and hormones c.Decreased involvement and intimacy of partner d.Increased spontaneity of coitus

ANS: B The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.

Importantly, the nurse must be aware of which information related to the use of IUDs? a.Return to fertility can take several weeks after the device is removed. b.IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c.IUDs offer the same protection against STIs as the diaphragm. d.Consent forms are not needed for IUD insertion.

ANS: B The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.

Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a.Fever higher than 39° C b.Chills c.Foul-smelling vaginal discharge d.Bleeding greater than four pads in 2 hours e.Severe abdominal pain

ANS: B, C, E The client should report to a health care facility for any of the following symptoms: fever higher than 38° C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.

The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) a.Sterilization should be performed under general anesthesia. b.Pain, bleeding, and infection are possible complications. c.Pregnancy may still be possible. d.Vasectomy may affect potency. e.Secondary sex characteristics are unaffected.

ANS: B, C, E Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected.

Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a.The ideal candidate for DMPA wants menstrual regularity and predictability. b.The client has a history of thrombotic problems or breast cancer. c.The ideal candidate has difficulty remembering to take oral contraceptives daily. d.The client is homeless or mobile and rarely receives health care.

ANS: C Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what? a.Avoid sexual contact for at least 10 days after starting the pill. b.Use condoms and foam for the first few weeks as a backup. c.Use another method of contraception for 1 week after starting the pill. d.Begin sexual relations once vaginal bleeding has ended.

ANS: C If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy.

In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document? a.B stands for birth control. b.R stands for reproduction. c.A stands for alternatives. d.I stands for ineffective.

ANS: C In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.

The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method? a.The natural family planning method is the same as coitus interruptus or "pulling out." b.This contraception method uses the calendar method to align the woman's cycle with the natural phases of the moon. c.This practice is the only contraceptive method acceptable to the Roman Catholic Church. d.The natural family planning method relies on barrier methods during the fertility phases.

ANS: C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. "Pulling out" is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers.

A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? a.Limit sexual contact for one cycle after starting the pill. b.Use condoms and foam instead of the pill for as long as the client takes an antibiotic. c.Take one pill at the same time every day. d.Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days.

What is the importance of obtaining informed consent for a number of contraceptive methods? a.Contraception is an invasive procedure that requires hospitalization. b.The method may require a surgical procedure to insert a device. c.The contraception method chosen may be unreliable. d.The method chosen has potentially dangerous side effects.

ANS: D Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching.

Which statement regarding the term contraceptive failure rate is the most accurate? a.The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b.It refers to the minimum rate that must be achieved to receive a government license. c.The contraceptive failure rate increases over time as couples become more careless. d.It varies from couple to couple, depending on the method and the users.

ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

Which statement is the most complete and accurate description of medical abortions? a.Medical abortions are performed only for maternal health. b.They can be achieved through surgical procedures or with drugs. c.Medical abortions are mostly performed in the second trimester. d.They can be either elective or therapeutic.

ANS: D Medical abortions can be either elective (the woman's choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." What is the nurse's mostappropriate response? a."This probably means that you're pregnant." b."Don't worry; it's probably nothing." c."Have you been sick this month?" d."You probably didn't ovulate during this cycle."

ANS: D The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, "Don't worry; it's probably nothing," discredits the client's concerns. Illness is most likely the cause of an increase in BBT.

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? a."No spermicide is used with the cervical cap, so it's less messy." b."The diaphragm can be left in place longer after intercourse." c."Repeated intercourse with the diaphragm is more convenient." d."The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later."

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)? a.COCs can cause TSS if the prescription is wrong. b.Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs. c.COCs increase the risk of endometrial and ovarian cancers. d.Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

ANS: D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.

A 35-year-old client with one child does not respond to ovulation-inducing drugs. On assessing the client's medical history, the nurse suspects early menopause. What could be the reason for the nurse's suspicion? The client has taken methyldopa. The client had a cranial injury. The client had a major surgery. The client had undergone chemotherapy.

Cancer treatments like chemotherapy or radiotherapy may reduce or completely halt ovarian function. Methyldopa is used to reduce blood pressure to normal levels. Methyldopa may cause hyperprolactinemia as a side effect. However, it does not cause early menopause. Cranial injury and surgeries are physical stressors, which may result in increased prolactin levels. However, the conditions are unrelated to early menopause. (D)

A client who had stimulated ovulation is given hormonal therapy to maintain the uterine lining. The client, however, has a spontaneous abortion while resting at home. What could be the probable reason for the spontaneous abortion? The client was administered exogenous estrogen as the main therapy. The client was administered exogenous estrogen as adjunct therapy. The client was administered exogenous progesterone as the main therapy. The client was administered exogenous progesterone as adjunct therapy

Progesterone is a hormone released by the ovaries. Progesterone plays a vital role in the implantation of the fertilized egg and in the maintenance of the pregnancy. Exogenous progesterone, when administered alone, cannot maintain the uterine lining, and, because of this, may result in abortion. In the case of stimulated ovulation, exogenous progesterone is effective in maintaining the uterine lining only if used as adjunct therapy. Exogenous estrogen is used to treat menopausal symptoms and osteopeorosis. It is unrelated to the maintenance of the uterine lining in stimulated ovulation. Therefore, exogenous estrogen is not beneficial as either the main therapy or as adjunct therapy. (C)

34. A patient has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? a. Nausea, hot flashes, and vaginal bleeding b. Vomiting, weight loss, and hair loss c. Nausea, vomiting, and diarrhea d. Hot flashes, weight gain, and headaches

a. Nausea, hot flashes, and vaginal bleeding

***A 36-year-old client is taking ovulation-inducing drugs to conceive after having had one child previously. The client says, "I've been using ovulation-inducing drugs for a month now and still haven't ovulated." How does the nurse respond? A. "You're likely too old to ovulate." B. "When did you have your last menstrual cycle?" C. "You may be sterile and unable to conceive naturally." D. "Continue using the medication a while longer."

The nurse should inquire about the client's last menstrual cycle as a way to begin exploring the details of the woman's menstrual cycle in the past month. Age 36 is not too old for a woman to ovulate. Generally, women enter the menopausal stage at the average age of 51. However, some women may enter menopause early. In the case of early menopause, the ovaries do not respond to ovulation-inducing drugs. Aging reduces the ability to conceive by reducing the functions of the ovaries. However, an ovulation-inducing drug stimulates the ovulation cycle. The scenario indicates that the client has conceived once previously, which indicates that the client is not sterile. Instructing the client to continue using the medication without explaining the reason may be nontherapeutic. (B)

14. As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that: a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment is steroids.

a. It is most commonly caused by anovulation.

6. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client's recent menstrual cycles. The nurse should collect additional information with which statement? a. The woman says her menstrual flow lasts 5 to 6 days. b. She describes her flow as very heavy. c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. d. She says the length of her menstrual cycle varies from 26 to 29 days.

b. She describes her flow as very heavy.

1. When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. b. Type 1 diabetes mellitus. c. Lack of exercise. d. Hysterectomy.

c. Lack of exercise.