Sem 3 - Unit 5 - Miscarriage/Fertility - NCO

Which medication is indicated for evacuation in case of a miscarriage? 1 Clomiphene 2 Dinoprostone 3 Magnesium sulfate 4 Methylergonovine

2 Dinoprostone Dinoprostone is a prostaglandin E 2 abortifacient and cervical ripening drug, which is indicated for uterine evacuation in cases of miscarriage. Clomiphene is indicated for female infertility in some clients. Magnesium sulfate is used to treat pregnancy-induced hypertension. Methylergonovine is used to treat postpartum uterine atony and hemorrhage.

A client who has just experienced her second spontaneous abortion expresses anger toward the practitioner, the hospital, and the "rotten nursing care." When assessing the situation, the nurse concludes that the client may be using which coping mechanism? 1 Denial 2 Projection 3 Displacement 4 Reaction formation

3 Displacement The client's anger about the miscarriage is shifted to the staff and the hospital because she is unable to cope with her loss at this time. The client is neither ignoring nor refusing to recognize reality. The client is not attributing unacceptable or undesirable thoughts or feelings to another; nor is she exhibiting a behavior pattern opposite to what she feels.

Which drug does the nurse anticipate to be prescribed to a client seeking treatment for infertility? 1 Clomiphene 2 Misoprostol 3 Dinoprostone 4 Methylergonovine

1 Clomiphene Clomiphene causes the maturation of ovarian follicles, which leads to ovulation. This drug is used to promote fertility. Misoprostol and dinoprostone are prostaglandins that cause uterine muscle contractions. Methylergonovine is an ergot alkaloid used to reduce postpartum uterine hemorrhage.

The nurse is caring for a client who has had a spontaneous abortion. Which complication should the nurse assess this client for? 1 Hemorrhage 2 Dehydration 3 Hypertension 4 Subinvolution

1 Hemorrhage Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth.

Hysterosalpingography (HSG) is performed to determine whether a client has a tubal obstruction. The nurse explains to the client that infertility caused by a defect in the tube is most often related to what? 1 A tubal injury 2 Past infection 3 A fibroid tumor 4 A congenital anomaly

2 Past infection Past pelvic infections may result in tubal occlusions, most of which are caused by postinfection adhesions. Although tubal injury is possible, tubal infections are more common. Fibroid tumor is a benign tumor of the uterus and does not affect the tube. Tubal congenital anomalies are rare; uterine anomalies are more common.

A woman who is infertile is diagnosed with primary ovarian failure. Which fertility drug regimen may be prescribed to treat infertility? 1 Clomiphene 2 Menotropins 3 Estrogens and progestins 4 Choriogonadotropin alfa

3 Estrogens and progestins Exogenous administration of estrogens or progestins is used to treat infertility associated with primary ovarian failure. The administration of clomiphene, menotropins, and choriogonadotropin alfa cannot stimulate the ovaries to increase the levels of estrogens or progestins.

A client who has been pregnant for 5 months experiences a spontaneous abortion after an accident. The client tells the nurse that she feels depressed over the loss of her son. She describes how he would have looked and how bright he would have been. What is the client demonstrating? 1 Panic level of anxiety 2 Typical grief syndrome 3 Pathological grief reaction 4 Diminished ability to test reality

2 Typical grief syndrome The client is grieving the loss of a fantasized child; talking about it is part of the typical grief reaction. The client is sad, not out of control or immobilized. The client is coping with the loss effectively. The client recognizes the loss, but is lamenting what could have been.

A client with a history of three spontaneous abortions is now at 16 weeks' gestation and attending the high-risk prenatal clinic. She expresses concerns about remaining at home during this pregnancy. Which questions will elicit responses most helpful to the nurse developing the client's plan of care? Select all that apply. 1 "Do you have a support system available to help you?" 2 "Have you been told about the status of your pregnancy?" 3 "Do you know the causes related to spontaneous abortions?" 4 "Are you aware of how a healthy lifestyle affects a pregnancy?" 5 "What are the characteristics of an impending spontaneous abortion?"

1 "Do you have a support system available to help you?" 2 "Have you been told about the status of your pregnancy?" The availability of support persons is important when the client is deciding how to try to maintain the pregnancy. Knowing the status of her pregnancy is helpful to the nurse planning her care. If the status is not known, the nurse can correct any misconceptions and assist the client in focusing on reality while helping ease her anxiety. The causes of spontaneous abortion are not always known; theoretic knowledge of the causes will not help the client maintain her pregnancy. Questions about the interrelationship of lifestyle and a healthy pregnancy may add to the client's anxiety; they are not relevant at this time. Questioning the client's knowledge of an impending spontaneous abortion may add to the client's anxiety; after three abortions the client probably knows what to expect before a spontaneous abortion.

A nurse in the fertility clinic is instructing a client who will be using progesterone gel vaginally in the treatment of luteal phase infertility. When discussing the side effects of progesterone, what should the nurse tell the client to expect? 1 Enlarged, tender breasts 2 Increased vaginal secretions 3 Additional facial and body hair 4 Decreased basal body temperature

1 Enlarged, tender breasts The hormonal influence of progesterone during the luteal phase of the menstrual cycle contributes to breast enlargement and tenderness. Vaginal secretions decrease, not increase, with the administration of progesterone. Loss of hair, not additional facial and body hair, is a side effect associated with the administration of progesterone. An increase, not decrease, in basal body temperature is associated with the administration of progesterone.

After 18 months of unsuccessful attempts at conception by a client, primary infertility related to anovulatory cycles is diagnosed. Clomiphene citrate is prescribed. When will the nurse instruct the client to take clomiphene? 1 Fifth day of her cycle 2 Last day of her period 3 Third day after her period begins 4 Sixteenth day of her cycle

1 Fifth day of her cycle The objective is to stimulate ovulation near the fourteenth day of the menstrual cycle, and this is achieved by taking the medication on the fifth through the ninth days; there is an increase in two pituitary gonadotropins, luteinizing hormone and follicle-stimulating hormone, with subsequent ovarian stimulation. On the third day after the cycle there are insufficient hormones for clomiphene to be effective. The sixteenth day of the cycle is also too late for clomiphene to be effective.

A woman has been administered clomiphene as part of a treatment for infertility. What assessments indicate that the drug is working effectively? Select all that apply. 1 Increased estrogens 2 Increased ovarian stimulation 3 Increased luteinizing hormone 4 Decreased follicle-stimulating hormone 5 Decreased gonadotropin-releasing hormone

1 Increased estrogens 2 Increased ovarian stimulation 3 Increased luteinizing hormone Decreased gonadotropin-releasing hormone Clomiphene acts by stimulating the hypothalamus in the treatment for infertility. This drug indirectly increases the levels of estrogens, which causes ovarian stimulation due to the increase in the levels of luteinizing hormone. Stimulation of the hypothalamus by clomiphene indirectly increases the level of follicle-stimulating hormone via the increased production of gonadotropin-releasing hormone from the hypothalamus.

A woman reports irregular menses and weight gain. Upon diagnosis, the woman has low hormone levels and is treated with infertility drugs to conceive. Which nursing interventions would be beneficial to this client? Select all that apply. 1 Monitor vital signs. 2 Encourage the client to track her medications in a journal. 3 Recommend the self-administration of oral drugs. 4 Recommend the long-term use of indomethacin orally. 5 Administer oral drugs to the client when the client wakes up along with six glasses of water.

1 Monitor vital signs. 2 Encourage the client to track her medications in a journal. 3 Recommend the self-administration of oral drugs. The nurse should monitor the client's vital signs to minimize the risk of hypotension. Journal tracking of medication helps to ensure the regular administration of the drug. Self-administration of oral drugs at home should be encouraged, and proper instructions regarding the administration should be provided to ensure rational use of the drug. The nurse should not advise the long-term oral use of indomethacin because it may cause birth defects. The administration of oral drugs upon rising with six glasses of water is the nursing intervention for administration of oral bisphosphonates in the treatment of osteoporosis.

The nurse is caring for a client who has had a spontaneous abortion. The client asks why spontaneous abortions occur. The nurse responds that they are most commonly caused by what? 1 Physical trauma 2 Unresolved stress 3 Congenital defects 4 Embryonic defects

4 Embryonic defects Approximately 75% of all spontaneous abortions take place between 8 and 12 weeks' gestation and reveal embryonic defects. Though possible, physical trauma rarely causes an abortion. Unresolved stress is rarely associated with spontaneous abortions. Congenital defects are asymptomatic during pregnancy and do not usually cause abortion.

At 12 weeks' gestation a client with a history of several spontaneous abortions says to the nurse, "Every day I wonder whether I'll be able to have this baby." How should the nurse respond? 1 "I can understand why you're worried; however, you'll have other chances in the future to get pregnant." 2 "You're getting the best of care. Please tell me about the problems with your previous pregnancies." 3 "It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time." 4 "Your pregnancy has lasted past the time when most early spontaneous abortions occur. I think you'll be able to continue the pregnancy." 00:00:40 Question Answer Confidence Buttons

3 "It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time." Affirming the validity of the client's concerns acknowledges her fearful feelings. It also permits further communication. Assuring the client that she will have other chances to get pregnant in the future does not acknowledge the client's feelings; it also instills fear by implying that the current pregnancy may not go to term, even though there is no evidence to indicate this. Asking the client to talk about the problems with her prior pregnancies does not acknowledge her feelings of fear and changes the focus of the conversation. Telling the client that she should be able to continue the pregnancy is false assurance and does not address the client's feelings.

The nurse is caring for a couple during their initial visit to a fertility clinic after being unable to conceive for 2 years. Which of the following assessment questions would be appropriate to determine an alternate cause of infertility? 1 "Do you use any lubrication during intercourse?" 2 "Can both of you reach orgasm at the same time?" 3 "What type of birth control did you use in the past?" 4 "Are you consistent in the manner in which you have intercourse?"

1 "Do you use any lubrication during intercourse?" Some lubricants act as a spermicide; they should be avoided, or only a recommended one should be used. A female orgasm is not necessary for conception; simultaneous orgasms is not a relevant question. The type of birth control before the couple began trying to conceive 2 years ago is not relevant at this time; some hormonal contraceptives should be discontinued 6 to 18 months before trying to conceive. Consistency in the manner of intercourse usually is not relevant to conception, although a change in position may be recommended.

A pregnant client who has type 2 diabetes and a history of three spontaneous abortions is scheduled for a contraction stress test. Before the test she begins to cry while answering the nurse's questions regarding her previous pregnancies. She states, "I know it's my diabetes. This baby will never live. It's all my fault." What is the best response by the nurse? 1 "This must be very stressful for you." 2 "Diabetes is a difficult disease to manage during pregnancy." 3 "This baby will live because it is being very closely monitored." 4 "I know you're worried, but getting upset can alter your test results."

1 "This must be very stressful for you." By acknowledging the situation is stressful for the client, the nurse empathizes with the client and keeps the lines of communication open without being judgmental. Stating that diabetes is a difficult disease to manage during pregnancy does not address the client's feelings and may increase the client's anxiety. Stating that the baby will live constitutes false reassurance; close monitoring does not guarantee a live baby. Stating that getting upset can alter test findings denies the client's right to emotions and may evoke more feelings of guilt about her obstetric history.

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history? 1 G4 T3 P2 A1 L4 2 G5 T2 P2 A1 L4 3 G5 T2 P1 A1 L4 4 G4 T3 P1 A1 L4

3 G5 T2 P1 A1 L4 The acronym GTPAL represents gravidity, term births, preterm births, abortions, and living children; G5 T2 P1 A1 L4 indicates that the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children. G4 T3 P2 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one, not two, preterm birth; one abortion; and four living children. G5 T2 P2 A1 L4 indicates that there were five pregnancies; two term births; twins counted as one, not two, preterm births; one abortion; and four living children. G4 T3 P1 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one preterm birth; one abortion; and four living children.

Which nursing assessment is important to recognize to determine the causative factors in a client with a history of spontaneous abortions? 1 Use of sex hormones 2 Use of contraceptive pills 3 Presence of heart problems 4 History of alcohol consumption

4 History of alcohol consumption Alcohol consumption during pregnancy may cause fetal abnormalities and increase the risk of spontaneous abortions. The presence of heart problems may not cause spontaneous abortions. The use of sex hormones in pregnancy may cause fetal abnormalities. Contraceptive pills may inhibit the ovulation process, but they rarely affect the embryo.

A female client is undergoing treatment for infertility. After therapy with clomiphene the client comes for follow-up visits and no results are seen. What further treatment does the nurse anticipate administering? 1 Estrogen 2 Progesterone 3 Human growth hormone 4 Human chorionic gonadotropin

4 Human chorionic gonadotropin Clomiphene is used to induce pregnancy by triggering ovulation. If the desired result is not obtained, the second alternative is to administer human chorionic gonadotropin and gonadotropin-releasing hormone to stimulate ovulation. A combination of estrogen and progesterone is generally administered to treat female clients who have a gonadotropin deficiency. Human growth hormone injections are administered to treat adults with growth hormone deficiency.

The nurse is interviewing a 41-year-old woman who is being seen in the infertility clinic for her first visit. She and her husband have been married for 3 years and have not used any form of contraception during this time. Neither the woman nor her husband has children from previous relationships. She asks the nurse what test or treatment will be done first. What should the nurse inform her that she and her husband should expect? 1 A laparoscopy 2 The start of fertility medication 3 A hysteroscopy 4 Semen analysis

4 Semen analysis Semen analysis is painless, is less costly than other interventions, and provides important information regarding the male partner's fertility. Fertility medication would not be initiated until an evaluation of ovulatory function had been completed. Simpler evaluations and therapies are completed before more complex efforts such as surgical procedures like laparoscopy and hysteroscopy are performed.