Exam 7

A husband is worried he has an inadequate sperm count. Which circumstance would be most important for the nurse to ask about during his health history?

You Selected: • if he eats a low-lipid diet Correct response: • if he works at a desk job Explanation: Excessive heat to testicles, such as that created by sitting for long periods, may interfere with sperm production or survival.

When using the contraceptive patch, a client should understand that it:

You Selected: • should be covered when swimming in a pool because of chlorine's effect on the adhesive. Correct response: • should be applied to the abdomen, buttocks, or back. Explanation: The patch should be applied only to the buttocks, back, abdomen, or torso (never the breasts). The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.

A patient who has unprotected intercourse has obtained the morning after pill but has not yet taken the prescribed dosage. What nursing diagnosis should the nurse identify as appropriate for the patient at this time?

• Readiness for enhanced knowledge Correct response: • Decisional conflict Explanation: The patient has the morning after pill but has not yet taken the prescribed dosage. This indicates that the patient has not yet made a decision. Powerlessness would be applicable if the patient's planned contraceptive was ineffective. Spiritual distress would be appropriate if there were a conflict regarding contraceptive methods. Readiness for enhanced knowledge would be applicable if the patient was asking about different contraceptive types.

A young woman comes into the clinic stating that she is pregnant and does not want to have a baby. After counseling, the woman decides to terminate the pregnancy by having an abortion. The nurse explains that the procedure will be what type of abortion?.

• Therapeutic abortion Correct response: • Induced abortion Explanation: Induced abortion is pregnancy termination at the request of the woman and is not related to preservation of her health.

A nurse is completing an informed consent on a client preparing for a tubal ligation. Which statement by the client would require the nurse to notify the health care provider?

You Selected: • "I will not be able to have children after this procedure." Correct response: • "I will be able to have my third child in about a year from now." Explanation: The nurse should recognize that the client does not understand the consequences of the procedure and therefore is required to call the health care provider. The health care provider needs to explain the procedure, consequences of the procedure, and answer any questions before the informed consent is signed.

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

You Selected: • Fear of the possible outcome of the testing • Guilt related to the lack of conception Correct response: • Guilt related to the lack of conception • Anger toward others who have conceived • Fear of the possible outcome of the testing Explanation: Couples who have experienced infertility may experience guilt related to the lack of conception, anger toward others, and fear of the outcome. The nurse should be prepared to visit with the couple regarding these feelings, and should view these feelings as a normal process.

A young client in the infertility clinic tells the nurse, "I just know it is my fault we cannot conceive." What would be the best response by the nurse?

Correct response: "The problem can be with the man, woman, or both." Explanation: When there is a problem with subfertility, the problem can be related to the man, woman, or both. It is important at this time to provide accurate information. While the nurse in Option B is trying to be supportive, the nurse should not introduce the idea of guilt or address outcomes that have not yet been identified before presenting factual information.

The nurse completes instructing a patient on the use of the contraceptive patch. Which patient response indicates that teaching has been effective?

Correct response: • The patch should be applied to the abdomen, buttocks, or back. Explanation: The patch should be applied only to the buttocks, back, abdomen, or torso and never on the breasts. The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.

A nurse is preparing a presentation for a health fair on the topic of vasectomy. Which information should the nurse point out in the information?

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

A male client is being evaluated for infertility. What additional data should a nurse obtain?

You Selected: • HIV status, testosterone, HCG, cholesterol Correct response: • testosterone, Rh factor, blood type, UA Explanation: The nurse should assess data related to testosterone levels, Rh factors for inflammation, blood type, and urinalysis.

A couple comes to the clinic and informs the nurse that they have been trying to conceive for 6 months with no success. The husband states that they have coitus at least 5 or 6 times per week to optimize their chance of success. What can the nurse educate the couple about frequency of coitus?

You Selected: • The couple should have coitus only when the female partner is ovulating. Correct response: • The couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count. Explanation: Couples who engage in coitus daily, hoping to cause impregnation, may actually have more difficulty conceiving than those who space coitus to every other day. This is because too frequent coitus can lower a man's sperm count to a level below optimal fertility.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation?

You Selected: • an ovulation suppressant Correct response: • a diaphragm and spermicide Explanation: Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated.

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

You Selected: • semen analysis of the partner • hormone injections • ovulation monitoring • tubal patency assessment Correct response: • semen analysis of the partner • ovulation monitoring • tubal patency assessment Explanation: Subfertility assessment used to require many months and numerous tests. Today, a subfertility investigation is usually limited to three assessments: semen analysis, ovulation monitoring, and evaluation of tubal patency. Medications, including hormone injections are part of the treatment depending on was as revealed in the assessment.

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

• Remain on the back for at least 3 minutes after intercourse. Correct response: • Elevate the hips on a small pillow after coitus. Explanation: A woman can facilitate sperm collection near the opening to the cervix by elevating her hips on a small pillow. A woman should remain on her back with the knees drawn up for at lest 20 minutes after ejaculation to help sperm remain near the cervix. She should not douche or use lubricants before or after intercourse to keep the vaginal pH unaltered. Alteration in vaginal pH could interfere with sperm motility.

A client is to take clomiphene citrate for infertility. Which outcome should the nurse explain is the expected action of this medication?

Correct response: • Stimulate the release of ova Explanation: Clomiphene citrate stimulates the release of FSH and LH which is responsible for the maturity and release of ovum from the ovary

A nurse is teaching a couple about how to use a condom. The nurse determines the couple can properly apply the condom when they state that it should be applied at which time to be most effective? You Selected:

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

A healthy 28-year-old female client who has a sedentary lifestyle and is a chain smoker is seeking information about contraception. The nurse informs this client of the various options available and the benefits and the risks of each. Which should the nurse recognize as contraindicated in the case of this client?

Correct response: combination oral contraceptives Explanation: Considering the client's smoking habit, combination oral contraceptives may be contraindicated. Oral contraceptives are highly effective when taken properly, but can aggravate many medical conditions, especially in women who smoke. The medroxyprogesterone injection or copper intrauterine devices are not contraindicated in this client and can be used with certain precautions. Implantable contraceptives are subdermal time release implants that deliver synthetic progestin; these are highly effective and are not contraindicated in this client.

A male is diagnosed as being infertile, but he wants to have children with his spouse. Which response should the nurse provide to this patient?

Correct response: • "You need to consider donor-alternative insemination." Explanation: Donor sperm (alternative insemination by donor) is used if the man has no sperm. There is no evidence to support that the chance of conception is slight with artificial insemination. Embryo transfer is for the female partner who does not produce ova. Artificial insemination is useful for many different situations.

A 40-year-old woman who smokes desires a reliable contraceptive method. Which should the nurse recommend to this patient?

Correct response: • A condom and spermicide Explanation: Women who are 40 years of age and smoke should not take ovulation suppressants. Irregular menstrual cycles make natural methods difficult. Women older than the age of 40 may have vaginal dryness, so a spermicidal suppository would not be effective. The best option is for the patient to use a condom and spermicide.

A client who delivered her baby 3 months ago is seen in the clinic and tells the nurse that she and her husband have yet to resume a sexual relationship. The nurse notes that no contraception is currently being used. What is the most appropriate nursing diagnosis for this client?

Correct response: • Altered sexual pattern related to fear of pregnancy Explanation: The nurse should recognize that this exceeds the recommended postpartum abstinence period and might be contributed to a fear of a repeat pregnancy.

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

Correct response: • change in the cervical mucus Explanation: Change in the appearance and consistency of cervical mucus is an indication of ovulation. Slight weight gain and abdominal cramps are not signs used to determine ovulation. At the time of ovulation, body temperature is slightly elevated.

A young couple is exploring their contraceptive options and are curious about using an intrauterine contraceptive device. The nurse explains that there are two types, one that uses hormones and one that uses:

Correct response: • copper. Explanation: The implants contain either copper or progesterone to enhance their effectiveness. One or two attached strings protrude into the vagina so that the user can check its placement. Four IUCs are currently available in the United States: the copper ParaGard-TCu-380A, the levonorgestrel-releasing intrauterine systems (LNG-IUSs) marketed as Mirena and Kyleena, and the LNG-IUD marketed as Jaydess.The ParaGard-TCu-380A is approved for 10 years of use and is nonhormonal. Its mechanism of action is based on the release of copper ions, which alone are spermicidal. Additionally, the device causes an inflammatory action leading to a hostile uterine environment.

A woman in the 15th week of gestation is planning on terminating the pregnancy. The procedure done for second trimester terminations is which of the following?

Correct response: • dilatation and extraction Explanation: Most second-trimester terminations (12 to 16 weeks' gestation) are done by dilatation and vacuum extraction. A dilatation and curettage is done when a pregnancy is less than 13 weeks. If the gestational age for a pregnancy is more than 16 weeks, a hysterotomy is done. A menstrual extraction is the simplest of all and is performed on the basis of 5 to 7 weeks after the last menstrual period.

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will:

Correct response: • increase a degree. Explanation: The effect of progesterone, released with ovulation, is to increase body temperature.

A young female patient who is about to go overseas on active duty in the army comes to the clinic and asks for birth control. After discussing the different options with the patient, which of the following would the nurse suggest as best for this patient?

Correct response: • low-dose estrogen/progestin pill (Lybrel) Explanation: Lybrel is a new U.S. FDA-approved low-dose combination estrogen and progestin pill taken 365 days a year without a placebo or pill-free interval, so menstrual periods are completely eliminated. Such pills are attractive to physically active women and those who work long schedules such as military deployment.

A young woman is newly married and is seeking advice on contraception. She is in a monogamous relationship and would like a temporary contraceptive, as she plans to have children in the future. Her husband dislikes the feel of condoms. Also, she mentions that she typically experiences dysmenorrhea and has a history of recurrent urinary tract infections. Which method should the nurse recommend?

Correct response: • oral contraceptive Explanation: An oral contraceptive would be the best choice of those listed for this client, as it is a temporary contraceptive that also can help relieve dysmenorrhea. Postcoital douching is ineffective as a contraceptive measure as sperm may be present in cervical mucus as quickly as 90 seconds after ejaculation. Diaphragms are contraindicated for women with a history of recurrent urinary tract infections. Vasectomy is a permanent measure and thus inappropriate in this situation.

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

Correct response: • overstimulation of the ovary resulting in potential multiple births Explanation: Therapy with clomiphene citrate may be used to stimulate ovulation. Administration of either clomiphene citrate or gonadotropins may overstimulate an ovary, causing multiple ova to come to maturity and possibly resulting in multiple births. The nurse should counsel women who receive these agents that this is a possibility. None of the other answers is a common effect of clomiphene citrate use.

A male patient comes to the clinic and informs the primary care provider that he and his wife are trying unsuccessfully to conceive. He adds that he cannot get an erection and believes this problem started when he began taking blood pressure medicine. What type of erectile dysfunction would be suspected?

Correct response: • secondary erectile dysfunction Explanation: Erectile dysfunction after previously being able to achieve ejaculation is referred to as secondary erectile dysfunction. Primary erectile dysfunction is when a man has never been able to achieve an erection. There is no tertiary erectile dysfunction. Sterility refers to an inability to conceive.

When teaching the client how to use a contraceptive sponge, the nurse must tell the client that leaving the sponge in place longer than 30 hours may lead to:

Correct response: • toxic shock syndrome. Explanation: The sponge provides protection for up to 12 hours but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.

A client desires protection from unwanted pregnancies. However, the client does not enjoy sex when her partner wears a male condom. Also, the client experiences breast tenderness, headache, and nausea after taking oral contraceptives. Which method would be the most likely choice for the couple to help them enhance their sexual experience as well as prevent any side effects?

Correct response: • transdermal contraceptive Explanation: Application of transdermal contraceptive patches to the skin would most likely be the option for this couple. These patches will not hamper the sexual experience nor cause side effects such as those caused by oral contraceptives. Natural membrane and polyurethane condoms are forms of male condoms, which the client does not like. Ethinyl estradiol is a combined oral contraceptive, which would most likely cause the client to experience breast tenderness, headache, and nausea.

A woman visits the family planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her?increase their risk further.

You Selected: • She has irregular menstrual cycles. Correct response: • She has a family history of thromboembolism. Explanation: The estrogen content of birth control pills may lead to increased blood clotting, leading to an increased incidence of thromboembolism. Women who already are prone to this should not increase their risk further.

Why is fertility testing initiated with sperm analysis of the male partner?

You Selected: Asking the male partner to undergo diagnostic procedures is the best way to assess his interest in treatment of infertility. Correct response: Sperm analysis is one of the easiest tests to complete. Explanation: Because sperm analysis is noninvasive, it is one of the easiest tests (and, therefore, most cost-effective) to complete.

The nurse in a primary care clinic and a client have come to see the primary care provider because the client is getting married and wants to have a prenuptial gynecologic examination. After the exam, the nurse asks about the woman's plan to have a family. The woman responds, "Why do I have to plan for a family?" What would be the nurses's best response? Correct response: • The couple can control the time between births when they plan their family. Explanation: Women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births.

The nurse in a primary care clinic and a client have come to see the primary care provider because the client is getting married and wants to have a prenuptial gynecologic examination. After the exam, the nurse asks about the woman's plan to have a family. The woman responds, "Why do I have to plan for a family?" What would be the nurses's best response? Correct response: • The couple can control the time between births when they plan their family. Explanation: Women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births.

A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client?

You Selected: • Ovulation stimulation Correct response: • In vitro fertilization Explanation: This client has damage to her fallopian tubes, so any procedure would need to bypass this structure. In vitro fertilization fertilizes an ovum and then inserts it into a women's uterus.

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

You Selected: • Sexual history • Surgical history • General health • Medication history Correct response: • General health • Medication history • Sexual history • Surgical history Explanation: The nurse will need to gather a thorough health history that will include information related to general health, medications, past sexual history, and surgical history.

A couple, both age 22, want to know what they can do to improve the chances of conceiving. What should the nurse respond to this couple?

You Selected: • The female-superior position is the best for conception. Correct response: • Have coitus every other day. Explanation: Although frequent intercourse may stimulate sperm production, men need sperm recovery time after ejaculation to maintain an adequate sperm count. This is why coitus every other day, rather than every day, during the fertile period will probably yield faster results. A diet that is low in fat and moderate in protein is recommended. The male-superior position is the best for conception because the sperm will be closer to the cervical opening.

A clinic nurse explains to a client who is undergoing an infertility workup that the patency of her fallopian tubes will be checked. Which test is currently used to do this?

• hysterosalpingography Explanation: Hysterosalpingography is radiologic examination with radiopaque contrast of the fallopian tubes. It is widely used to assess the patency of the fallopian tubes in women who are subfertile.

A female patient has forgotten to take an ovulation suppressant for two mornings in a row. What should the nurse advise the patient to do?

• Take two pills now and use a second method of contraception for the remainder of the month. Explanation: If two consecutive active pills are missed, the patient should be advised to take two pills immediately. Then the patient should continue the following day with the usual schedule. Missing two pills may allow ovulation to occur, so an added contraceptive such as a spermicide should be used for the remainder of the month. The patient does not need to take two pills every day for the rest of the month, take three pills and abstain from coitus, or start a new cycle of 21 pills.

A male client visits a fertility clinic after one year of attempting unsuccessfully to impregnate his wife. What is a risk factor associated with male infertility?

• no or few sperm cells produced Explanation: Azospermia or oligospermia (no or few sperm cells produced) is a risk factor affecting male infertility. Normally, the volume of semen ejaculated needs to be about 2-5 mL, with a density of sperm at about 20 million/mL. In addition to the number of sperm, the motility (movement), viability, and morphology (shape) of the sperm must be within normal limits.