MCN - Unit 1 - Chapter 4: Common Reproductive Issues

A 52-year-old client reports recent onset of hot flashes, fatigue, and vaginal dryness. While assessing the client, which response should the nurse prioritize? "Is this causing any issues between you and your partner?" "I will schedule you an appointment with your gynecologist." "Tell me what you are currently doing to manage these symptoms?" "I will request you have your calcium level checked today."

"Tell me what you are currently doing to manage these symptoms?" The client is exhibiting signs of perimenopause, which is managed by treating the symptoms. The nurse first needs to know what, if anything, the client is doing to manage the symptoms. The nurse would then make recommendations for the client to manage symptoms. Once the client provides information on current treatment options, the nurse may determine if there are concerns with the client's sexual relationship. There is no need for the client to be referred to a specialist to treat perimenopausal symptoms because the client is having expected symptoms. Osteoporosis can occur in clients during menopause. A bone mineral density (BMD) test, however, is the primary test used to identify osteoporosis, not calcium levels.

The nurse educates a 15-year-old female client on ways to prevent pregnancy. Which statement will the nurse include in the teaching? "Oral contraceptive pills are effective at preventing pregnancy as long as you take one each week." "The withdrawal method is effective as long as you have a monogamous partner." "The use of a condom is a method often recommended to prevent pregnancy for people your age." "If you do not want to become pregnant within the next 10 years, an intrauterine device would be best."

"The use of a condom is a method often recommended to prevent pregnancy for people your age." The nurse would state condoms as the best option for preventing pregnancy for this age group. Oral contraceptives are also effective but must be taken daily at approximately the same time. The withdrawal method is not effective, regardless of the number of sexual partners because sperm can be released before ejaculation occurs. An intrauterine device could be removed if the client desired pregnancy in the upcoming years.

The nurse is caring for a pregnant woman in her third trimester who is HIV positive. The client voices concerns about how to prevent transmitting HIV to her infant. Which response by the nurse is most appropriate? "Your infant will be tested after birth to determine if the virus is present and, if not, we will discuss how to avoid future transmission." "You will not be able to breastfeed your infant once born. Your infant will need to receive formula." "Your infant will begin receiving antiretroviral therapy immediately if tests show the infant is HIV positive." "This is something you need to discuss with your infant's health care provider."

"You will not be able to breastfeed your infant once born. Your infant will need to receive formula." Receiving appropriate antiretroviral treatment during pregnancy and birth and refraining from breastfeeding substantially reduce the risk of perinatal transmission of HIV. Telling the client to wait until the infant is tested is not appropriate because methods, such as not breastfeeding and starting medications, should begin before results are available. Antiretroviral therapy would begin at birth, not after test results are available. The medication may be stopped if results for HIV are negative. Stating this should be discussed with the health care provider is not appropriate because the nurse can provide education to the client.

A 35-year-old client visits the clinic reporting the inability to conceive after trying for the past year. The nurse discusses reasons for infertility with the client. The nurse evaluates client understanding of the causes of infertility. The nurse determines client understanding of causes of infertility when the client states the following

: "A history of sexually transmitted infections may cause infertility.", "Abnormalities of the uterus may contribute to infertility." , and "Women older than 35 may have difficulty conceiving.". Women's fertility gradually declines with age, especially in the mid-30s, and it drops rapidly after age 37. Abnormalities of the uterus can affect fertility. Pelvic surgery can damage and scar the fallopian tubes, which link the ovaries to the womb. Cervical surgery can also sometimes cause scarring or shorten the neck of the womb (the cervix). A history of sexually transmitted infections can contribute to infertility. Nutritional deficiencies can affect infertility, especially if the client is obese. Environmental factors can affect fertility, especially if the pregnant client is exposed to toxins.

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

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

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

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

A nurse is counseling women on birth control choices. Which woman is the best candidate for an IUD? a woman who has multiple sex partners a woman who has a history of PID a woman who is in her early twenties and wants children later in life a woman who has one partner and three children

a woman who has one partner and three children A women who is in a stable monogamous relationship and has already had one successful pregnancy is the best candidate for an IUD. An IUD is not without risk to a woman. IUDs do not protect against STIs. PID may be caused by IUDs. A woman in her twenties has several better, lower risk options.

A client prescribed oral contraceptive pills (OCPs) has presented for a routine visit. Which finding, if reported by the client upon assessment, should the nurse prioritize? abdominal pain small amount of breakthrough bleeding light menstrual flow cramping during menses

abdominal pain The warning signs to report for a client on OCPs are severe abdominal or chest pain, dyspnea, headache, weakness, numbness, blurred or double vision, speech disturbances, or severe leg pain and edema. Light bleeding, light flow, and cramping are all normal.

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

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

The nurse is assessing a 52-year-old perimenopausal female who is concerned about the changes occurring in her body. When questioned about the most serious changes, which effect should the nurse point out? pelvic support muscles lose tone dense breast tissue is replaced with adipose tissue the uterus and ovaries decrease in size bone mineral density decreases

bone mineral density decreases As women age, the decrease in hormone levels places women at increased risk for osteoporosis. This is a potential concern that can impact life, and bone mineral density should be monitored. There is no evidence of atrophy in the pelvic muscles, nor in the uterus or ovaries as related to menopause. Breast tissue changes at the same rate that all other tissue changes.

A nurse is working with a couple who is dealing with infertility. Which aspect would be most important for the nurse to consider? culture insurance restrictions family budget emotional limits

culture Infertility is not only a physiologic problem but is also one that can initiate a life crisis that is experienced with psychologic, familial, social, and cultural consequences. Although insurance constraints, budget, and emotional aspects are important considerations, the manner in which the various cultures, ethnic groups, and religious groups perceive and manage infertility are very different and must be considered when working with couples who have been unable to conceive. Nurses need to include awareness of these differences in their counseling of the couples as they try to help them achieve their goal of getting pregnant.

The nurse should carefully screen a client who insists on using only oral contraceptive pills (OCPs) for which contraindication? deep vein thrombosis gastrointestinal disease impaired absorption use of alcohol

deep vein thrombosis The nurse should screen the client for deep vein thrombosis (DVT), migraine headaches, neurological symptoms, coronary artery disease or cerebral vascular disease, severe diabetes, hypertension, liver disease, breast or endometrial cancer, and unexplained vaginal bleeding when oral contraceptive pills (OCPs) are used. Gastrointestinal diseases are contraindicated in the use of progestin-only pills. OCPs are not contraindicated in clients who drink alcohol. Impaired absorption is a contraindication for the use of progestin-only pills (mini-pills).

A 32-year-old client is undergoing investigation for subfertility. The client had a previous ectopic pregnancy treated with methotrexate 14 months ago. What procedure does the nurse anticipate? hysterosalpingogram laparoscopy ultrasound clomiphene citrate challenge test

hysterosalpingogram The previous ectopic pregnancy could have resulted in scarring or damage to the client's fallopian tube. A hysterosalpingogram is the insertion of contrast dye under x-ray monitoring to visualize the patency of the fallopian tubes. The dye insertion can break up minor adhesions, or plans can be made for microsurgery or alternate treatments such as in vitro fertilization if the fallopian tubes are not patent. Laparoscopy, clomiphene citrate challenge test, and ultrasound do not assess/treat the potential damage to the fallopian tube and would only be completed at future stages of subfertility investigation if indicated.

A woman and her partner have been unable to conceive. The female client's chart reveals a history of pelvic inflammatory disease (PID), oral contraceptive usage for 5 years, blood pressure 98/72 mm Hg, pulse 78 beats/min, temperature 99°F (37.2°C), and white blood cell (WBC) count 9,500 mm3 (9.5 x 109/l). Which order will the nurse anticipate for this client? hysterosalpingography serum estrogen and progesterone testing urinalysis oral antibiotic therapy

hysterosalpingography The client has a history of PID, which can cause scarring to occur in the fallopian tubes and lead to subfertility from blocked tubes. A hysterosalpingography is used to examine the inside of a client's fallopian tubes to help diagnose blockages. The other client findings are normal; therefore, no additional testing is indicated at this time.

A client comes to the clinic for termination of pregnancy via medication. Which potential complication(s) will the nurse point out as possible with this type of procedure? Select all that apply. incomplete abortion prolonged bleeding infection pneumonia hypoglycemia

incomplete abortion prolonged bleeding infection Complications associated with termination of pregnancy via medication include prolonged bleeding and incomplete abortion. Infection is a risk with all forms of abortion. Pneumonia and hypoglycemia are not related to any form of abortion.

The nurse informs the client that a diaphragm is an example of which type of contraception? chemical barrier mechanical barrier transdermal intrauterine

mechanical barrier The diaphragm is an example of a mechanical barrier. It is a circular rubber disk placed over the cervix before intercourse.

About which childhood communicable disease should the nurse question the male client who is seeking information about subfertility? measles rubella chickenpox mumps

mumps Diseases such as mumps orchitis (testicular inflammation and scarring because of the mumps virus) can result in obstruction.

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

oral contraceptive pills (OCPs) Oral contraceptive pills (OCPs) are contraindicated for women who smoke; these women would be at a higher risk for blood clots. Condoms, coitus interruptus, and spermicides can be used at no risk.

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

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

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? overstimulation of the ovary resulting in potential multiple births extensive bleeding during menstruation elevation of her blood glucose level hypertension

overstimulation of the ovary resulting in potential multiple births 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.

work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply. ovulation tubal transport diabetes impaired implantation lack of exercise

ovulation tubal transport impaired implantation Female factors that cause subfertility are problems with ovulation, tubal transport, and implantation.

A client is diagnosed with endometriosis. As part of the teaching plan, the nurse is explaining the condition, including the ways that the diagnosis would be confirmed. The nurse determines that the teaching was successful when the client states that which test would confirm the diagnosis? pelvic laparoscopy bimanual exam pelvic ultrasound Papanicolaou test

pelvic laparoscopy A thorough history and pelvic examination may lead the health care practitioner to suspect endometriosis; however, the only certain method of diagnosing it is by visualizing it via a laparoscopy. A tissue biopsy can be obtained at this time and examined microscopically to confirm it. A Papanicolaou test would be done to rule out cervical cancer. A pelvic ultrasound would not be definitive for endometriosis.

The nurse is developing a presentation for a group of young adult women about premenstrual syndrome. Which treatment options should the nurse point out as most appropriate? Select all that apply. antipsychotic medications reduction of caffeine intake vitamin and mineral supplements decrease in water intake NSAIDs

reduction of caffeine intake vitamin and mineral supplements NSAIDs Treatment options for PMS include lifestyle changes such as reduction in caffeine intake, a well-balanced diet with increased water intake, and limited alcohol intake. Vitamin and mineral supplements, NSAIDs, and diuretic therapy may be used. Antidepressants and antianxiety agents, not antipsychotic agents, may also be options.

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? Gamete intrafallopian transfer In vitro fertilization Surrogate mother Ovulation stimulation

In vitro fertilization 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.

The nurse is assessing a male client who is concerned about his ability to produce enough sperm to have a child. He tells the nurse, "I have had some issues in my younger years." What questions would be important for the nurse to ask this client? Select all that apply. "Do you use drugs or use alcohol excessively? "Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?" "When was the last time you had sex?" "Do you have a regular girlfriend?"

"Do you use drugs or use alcohol excessively? "Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?" Conditions that may inhibit sperm production are trauma to the testes, surgery on or near the testicles that results in impaired testicular circulation, and endocrine imbalances, particular of the thyroid, pancreas, or pituitary glands. Drug use or excessive alcohol use and environmental factors such as exposure to X-rays or radioactive substances have also been found to negatively affect spermatogenesis. Men exposed to radioactive substances in their work environments should be provided adequate protection for the testes.

A nurse is educating a client on the basal body temperature method as a form of contraception. Which statement by the client indicates an understanding of when she can expect to see a rise in her temperature? "My temperature will increase with the start of my menses." "If I am pregnant, I will have a temperature spike." "There will be an increase in my temperature right before I ovulate." "Immediately following ovulation my temperature will increase."

"Immediately following ovulation my temperature will increase." The basal body temperature dips immediately prior to ovulation; when ovulation occurs there will be an increase in temperature.

A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching? "Right after surgery, my semen will be sperm-free." "I will have this done in my urologist's office." "I will be awake and will get local anesthesia." "I will be able to go back to work in a day or two."

"Right after surgery, my semen will be sperm-free." After vasectomy, semen no longer contains sperm. However, this is not immediate. The man must submit semen specimens for analysis 8 to 16 weeks after a vasectomy until two specimens show that no sperm is present. When the specimen shows azoospermia, the man's sterility is confirmed. A vasectomy is usually performed under local anesthesia in a urologist's office, and most men can return to work and normal activities in a day or two.

A newly married couple asks the nurse which "natural" way of family planning would be most effective in preventing pregnancy. What is the most appropriate response by the nurse? "I believe that abstinence would work best for your life choices." "Coitus interruptus is the easiest method and most reliable." "By checking your cervical mucus you will know when to abstain." "The basal body temperature method is simple and has a low failure rate."

"The basal body temperature method is simple and has a low failure rate." The nurse should advise the couple on the most reliable and realistic natural method for this newly married couple. The basal body temperature method requires the couple to monitor changes in the woman's body temperature immediately after waking and to track the woman's daily temperature. When the client notices a slight dip in temperature followed by an increase, she knows she has ovulated and should refrain from sex for 3 days.

A 40-year-old client is a high profile local politician and exercises on a daily basis. She states to the clinic nurse "We stopped using birth control 7 months ago and I still have not gotten pregnant. Should we be worried?" What is the nurse's best response? "You are young, give it some more time." "Infertility is defined as 1 year of not getting pregnant." "You are very busy, are you sure you are ready to have a baby?" "You should tell the health care provider today during the visit."

"You should tell the health care provider today during the visit." Clients over the age of 35 should be evaluated after 6 months of not conceiving and therefore the nurse's best response would be to ensure that the client tell the health care provider of her concerns. While it is generally true that infertility is defined as a year of not conceiving, this client is 40 years old. A client under the age of 35 would be advised to wait a year before telling a health care provider of their concerns. Telling the client that they are young or that they are busy is not helpful to the client's concern.

A nurse should instruct a client who has a very low sperm count to make which lifestyle modification? Have intercourse every other day. Have intercourse only once a month. Abstain from intercourse for 8 days at a time. Abstain from intercourse for 15 days at a time.

Abstain from intercourse for 8 days at a time. The nurse should advise the client to abstain from intercourse for 7 to 10 days at a time to increase sperm counts.

A priority nursing diagnosis based on Maslow's Hierarchy of Needs for a client with endometriosis would be: Chronic Pain related to bleeding and endometrial pelvic implants. Deficient Knowledge related to diagnosis and treatment. Ineffective Breathing related to pain. Anxiety related to effect of endometriosis on fertility.

Chronic Pain related to bleeding and endometrial pelvic implants. According to Maslow, pain would be the highest priority since breathing difficulties are not usually a problem with endometriosis.

The nurse is teaching a client about a vasectomy. The nurse determines the session is successful when the client correctly chooses which fact concerning the vasectomy? It's usually done as an office procedure. The client will no longer ejaculate. Client may notice permanent increased scrotal swelling. The testes will no longer produce sperm.

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

A nurse is providing medication teaching related to oral contraceptive pills (OCPs) that a client is being given to prevent unwanted pregnancy. Which is the most important intervention for the nurse to include? Use a second form of contraception for the initial seven days on the OCPs. Begin the pills as soon as they are prescribed. Eliminate the 7 placebo pills to skip your menses. Take the pill at the same time every day and never double the dose.

Use a second form of contraception for the initial seven days on the OCPs. OCPs are not effective for the first 7 days, so the priority intervention the nurse should include would be for the client to use a second form of contraception during this time.

A woman at the fertility clinic for the first time asks, "What could have caused my infertility?" After teaching the woman about possible causes, the nurse determines that the teaching was successful when the woman identifies which condition as a common cause? Select all that apply. vaginal pH of 4.2 endometriosis history of ovarian tumor pelvic inflammatory disease (PID) anovulation

endometriosis pelvic inflammatory disease (PID) anovulation Common causes of female infertility include ovarian dysfunction, tubal and pelvic disorders, cervical mucus factors, and vaginal problems. A normal vaginal pH is 4-5.

A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply. ovulation tubal transport diabetes impaired implantation lack of exercise

ovulation tubal transport impaired implantation Female factors that cause subfertility are problems with ovulation, tubal transport, and implantation.

The nurse was teaching a college student how to properly take the prescribed oral contraceptive pills (OCPs). The nurse determines the session is successful when the client correctly chooses which instruction to follow when taking the OCP? empty stomach, full glass of water same time of day, each day take with a meal same day of the week, once a week

same time of day, each day OCPs are to be taken daily at the same time of day every day. Absorption is not affected by the stomach contents. Oral contraceptive pills must be taken every day to be effective.

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

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

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 contraceptive pills (OCPs). 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? natural membrane condom polyurethane condom transdermal contraceptive ethinyl estradiol

transdermal contraceptive 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 contraceptive pills (OCPs). Natural membrane and polyurethane condoms are forms of male condoms, which the client does not like. Ethinyl estradiol is an oral contraceptive pill, which would most likely cause the client to experience breast tenderness, headache, and nausea.

A pregnant client states they are interested in having a tubal ligation following the birth of the child. Which statement by the nurse is a priority at this time? "A tubal ligation is an effective method for permanent sterilization." "There are risks and complications associated with having this procedure." "You should discuss other forms of birth control with your health care provider first." "Your partner needs to understand the permanence of this procedure as well."

"A tubal ligation is an effective method for permanent sterilization." The nurse needs to be certain the client understands tubal ligation is an effective procedure for permanent sterilization. It involves ligating (tying off) the fallopian tubes so that ova cannot travel through them to the uterus, thus preventing conception. The health care provider will discuss risks and complications with the client prior to planning for the procedure. It is good for the client to be informed of other options; however, if the client desires this procedure, other methods should not be encouraged unless medically necessary. It is ideal for the client's partner to understand the procedure; however, it is not required for the partner to be involved or know of the procedure. If the partner is involved, it is a priority for the client to understand that it's the client's decision.

The nurse is providing care to a female client and spouse who have completed several rounds of unsuccessful in vitro fertilization. The client still desires to have a child. Which response by the nurse is appropriate? "It would be wise for you and your spouse to consider life without children." "Have you and your spouse considered using a surrogate mother?" "I recommend you continue trying in vitro fertilization if you desire to have a child." "Can you tell me more about your desire to have children?"

"Have you and your spouse considered using a surrogate mother?" The nurse would discuss other options for this client at this time. In vitro fertilization has shown to be unsuccessful for this client. A surrogate mother is a woman who agrees to carry a pregnancy to term for a subfertile party and could be a good option for this client and spouse. It is not appropriate for the nurse to recommend childless living or for the client continuing in vitro fertilization without appropriate rationale. It is not therapeutic for the nurse to ask for more information on the client's desire to have children. At this time, other options should be explored before the conversation is had regarding not having children.

The nurse is conducting a health history on a couple planning to become pregnant over the next few months. Which statement by the male client most concerns the nurse? "I consume fast food a few times each week and enjoy a few beers on the weekends." "My uncle and his wife have not been able to conceive a child." "I have severe asthma and use my inhaler several times each month." "I have a degree as a chemical engineer and work at the local plant."

"I have a degree as a chemical engineer and work at the local plant." The client works around chemicals that could cause infertility issues. The nurse should further question the client as to what types of chemicals he is exposed to and what type of precautions are taken to protect him. Eating fast food and occasionally consuming alcohol are not risk factors for infertility. The client does not state a direct family member having issues with conception. An uncle is not concerning; however, a brother would be of concern. The client's asthma status should be monitored; however, this is not an issue regarding fertility.

A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make? "Adoption is always an acceptable option for anyone." "I will call the health care provider to come visit with you." "The use of surrogates is more acceptable today." "Being childless is not as bad as you think it is."

"I will call the health care provider to come visit with you." The nurse needs to notify the health care provider because the client does not have a clear understanding of the outcomes of the procedure in which she is about to undergo.

A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success? "If you have been trying for this long without success, something must be wrong. So we will need to run a series of tests to see what that is." "Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." "Being this overweight is unhealthy for you and for any child that you may bring into the world. Before you consider conceiving, you should lose weight." "Weight has no bearing on the ability to conceive. Something else must be going on with your reproductive organs."

"Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." Extreme obesity in a male may interfere with effective penetration and deposition of sperm, compromising the ability to conceive.

A client is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that further teaching is needed? "The primary care provider will transfer my fertilized eggs into the uterus." "The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." "I will receive fertility drugs to stimulate ovulation." "The primary care provider will harvest eggs from my ovary."

"The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." In vitro fertilization (IVF) is a procedure used when the client has absent or blocked fallopian tubes, when the client has a low sperm count, or when the etiology of infertility is unknown. Oocytes are fertilized in the lab and transferred to the uterus.

The nurse is caring for a client requesting oral contraceptive pills (OCPs). She has multiple sexual partners. The nurse recommends condoms to the client, but the client states, "I cannot use condoms because I am allergic to latex." Which response by the nurse is appropriate? "I will let the health care provider know you desire oral contraceptive pills." "You can still use condoms because they make latex-free condoms." "We can have you allergy tested to see if certain condoms may work for you." "Do you understand the potential ramifications of having multiple sexual partners?"

"You can still use condoms because they make latex-free condoms." Because this client has multiple partners, there is concern over the risk for sexually transmitted infections (STIs) as well as pregnancy. Condoms are the only method of contraception that protects against STIs, which is an important concern if the client is not in a monogamous relationship. The nurse would inform the client of latex-free condoms and where to purchase them first. Regardless of whether the client chooses to use latex-free condoms, the client can discuss other options for contraception with the health care provider at that time. There is no need to have the client tested for latex sensitivity. The nurse should educate the client on risks associated with multiple sexual partners; however, using therapeutic language will be most effective.

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? Altered sexual pattern related to fear of pregnancy Spiritual distress related to partner's preference for contraception Decisional conflict related to unintended pregnancy Powerlessness related to failure of chosen contraceptive

Altered sexual pattern related to fear of pregnancy The nurse should recognize that this exceeds the recommended postpartum abstinence period and might contribute to a fear of a repeat pregnancy.

A client expresses interest in having an intrauterine device (IUD) placed for contraception. Which finding noted in the health history would indicate to the nurse that this would not be an appropriate contraceptive option? Sexually active since 16 Dysmenorrhea G1P0 Bicornuate uterus

Bicornuate uterus The client has an abnormally shaped uterus, which could be a contraindication for the use of an IUD due to increased risk for uterine wall perforation. All other findings would not contraindicate the device.

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

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

A nurse is visiting with a couple who has recently completed subfertility assessments and are awaiting the results. Throughout the conversation the wife intermittently begins to cry. What would be the most appropriate nursing diagnosis for this couple? Hopelessness related to perception of no viable alternative to usual conception Anticipatory grieving related to failure to conceive or sustain a pregnancy Situational low self-esteem related to the apparent inability to conceive Fear related to possible outcome of subfertility studies

Fear related to possible outcome of subfertility studies The nurse should recognize that the client may be expressing fear related to the possible outcomes of the testing. The nurse should address those fears with the client and answer any questions to help reduce fears.

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

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

Relatively easy procedure with few complications 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.

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 nurse's best response? Families are always best when pregnancies are not planned. The couple can control the time between births when they plan their family. An unwanted pregnancy can always be aborted. The couple can decide on a method of birth control.

The couple can control the time between births when they plan their family. Women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births with family planning.

A nurse is providing follow-up teaching to a client regarding the medically induced termination of her pregnancy. Which assessment finding should the nurse tell the client to report to the health care provider? Select all that apply. Oral temperature of 101.5°F (38.6℃) Vaginal bleeding of more than two pads per hour Severe depression or sadness Severe abdominal pain Mild cramping

Vaginal bleeding of more than two pads per hour Severe depression or sadness Severe abdominal pain The nurse should educate the client to notify the health care provider if there is vaginal bleeding of more than two pads an hour, severe abdominal pain or tenderness, and severe depression or sadness. The client should contact the health care provider if an oral temperature of greater than 102.4°F (39.1℃) or abdominal pain or tenderness occurs.

A client with liver disease is seen in the clinic wanting to begin contraception. The nurse recognizes that which type of contraception is best for this client? Oral contraceptive pills (OCPs) Subdermal hormone implant Intramuscular injections Vaginal estrogen/progestin (contraceptive) ring

Vaginal estrogen/progestin (contraceptive) ring The nurse should recognize that the vaginal estrogen/progestin ring releases hormones into the mucous membranes of the vagina and avoids the "first pass" through the liver.

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

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

A female client is having a procedure this morning that involves radiologic examination of the fallopian tubes using a radiopaque medium. What procedure should the nurse document as being performed? a uterine endometrial biopsy a sonohysterography a hysterosalpingography a hysteroscopy

a hysterosalpingography A hysterosalpingography, a radiologic examination of the fallopian tubes using a radiopaque medium, is a frequently used technique.

A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence? cervical infection a weight gain of 10 lb (4.5 kg) a vaginal infection six months of nonuse

a weight gain of 10 lb (4.5 kg) A substantial weight gain or weight loss of 10 pounds (4.5 kilograms) or more may shift the relationship of pelvic organs enough that the diaphragm no longer fits correctly.

A 16-year-old girl is brought to the clinic by her mother because she has not had a menstrual period for the past 8 months. Which findings might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? Select all that apply. hyperthermia bradycardia hypotension reduced subcutaneous fat evidence of secondary sex characteristics

bradycardia hypotension reduced subcutaneous fat Hypothermia, bradycardia, hypotension, and reduced subcutaneous fat may be observed in women with amenorrhea with anorexia nervosa as the contributing factor. Evidence of secondary sex characteristics would be a normal finding for a girl of this age.

A woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by: dilating the cervix. acting as a toxin to the trophoblastic tissue. blocking the action of progesterone on the endometrium. causing uterine contractions to expel the uterine contents.

causing uterine contractions to expel the uterine contents. Misoprostol works by causing uterine contractions, which help to expel the uterine contents. It has no effect on cervical dilation. Methotrexate is toxic to the trophoblastic tissue. Mifepristone blocks the action of progesterone, which is responsible for preparing the endometrium for implantation and then maintenance of the pregnancy.

The nurse is assessing the health history of a male partner. Which data is most likely to be related to an infertility problem? 30 years of age employment as a taxi driver intercourse approximately every third day immunization against mumps as a child

employment as a taxi driver Excessive testicular heat, which can occur from long periods of sitting, can limit sperm production and mobility.

A nurse is conducting education classes at the local high school on reproductive life planning. Which would be appropriate for the nurse to implement during the teaching? Select all that apply. encouragement of abstinence proper condom application various religious viewpoints sexually transmitted infection statistics nurse's personal opinion on abortion (elective termination of pregnancy)

encouragement of abstinence proper condom application sexually transmitted infection statistics The nurse should talk about all safer sex options, including abstinence and its 100% effectiveness. Within that teaching it is important to educate adolescents on the proper techniques for application of a condom as well as to discuss statistics related to sexually transmitted infections.

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? if he works at a desk job if he maintains a low-lipid diet if he jogs frequently if he takes a vitamin supplement

if he works at a desk job Excessive heat to testicles, such as that created by sitting for long periods, may interfere with sperm production or survival.

The nurse is preparing to assess a client who is noted to have a history of dysmenorrhea. The nurse predicts the client will report which potential symptom during the examination? intermittent, sharp suprapubic pain abnormally long, heavy menstrual periods dysphoria chronic pelvic pain

intermittent, sharp suprapubic pain Sharp, intermittent spasms of pain, usually in the suprapubic area, are a common report associated with dysmenorrhea. Menorrhagia refers to abnormally long, heavy periods. Dysphoria is a common report associated with premenstrual syndrome. Chronic pelvic pain is commonly associated with endometriosis.

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

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

A 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? the medroxyprogesterone injection oral contraceptive pills (OCPs) a copper intrauterine device implantable contraceptives

oral contraceptive pills (OCPs) Considering the client's smoking habit, oral contraceptive pills 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.

Which description best explains the hysterosalpingogram procedure? insertion of an endoscope through the posterior fornix to visualize the reproductive organs instillation of carbon dioxide through the cervix into the uterus and fallopian tubes passage of an endoscope through a small abdominal incision to inspect the reproductive organs radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix

radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix Hysterosalpingogram is a procedure to document the patency of the fallopian tubes through the use of a radiopaque medium.

A nurse is preparing a presentation for a client who is considering contraception. When discussing oral contraceptives, the nurse would identify which advantages? Select all that apply. decreased risk of breast cancer shortening of the menstrual period reduction in severe cramping lowered risk of migraine headaches reduction in risk for osteoporosis

shortening of the menstrual period reduction in severe cramping reduction in risk for osteoporosis Oral contraceptives are associated with shortening and regulating the menstrual cycle, reducing severe cramping and bleeding, and reducing the risk for osteoporosis. They are also associated with an increased risk for breast cancer and migraine headaches.

A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time? midway between the normal menstrual cycle three days before and three days after ovulation six days before the onset of menstruation five days after the first day of the menstrual cycle

three days before and three days after ovulation Typically, the unsafe period during the menstrual cycle is approximately 3 days before and 3 days after ovulation. An ovum is released from the ovary 14 days before the next menstrual period.

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: toxic shock syndrome. pelvic inflammatory disorder. sexually transmitted infections. cervical inflammation.

toxic shock syndrome. 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.

The nurse is educating a class of high school students on safe sexual practices. The nurse knows the group understood the content when a group member makes which statement? "A diaphragm can be used by males and females." "A condom is the best way to prevent pregnancy." "Spermicide should be applied immediately following intercourse." "Abstinence is the only way to prevent the spread of sexually transmitted infections."

"Abstinence is the only way to prevent the spread of sexually transmitted infections." The nurse knows the group understood the teaching when a group member states abstinence as the only way to guarantee not spreading a sexually transmitted infection (STI). Diaphragms can only be used by female clients and are placed directly in front of the cervical opening. While condoms are effective ways to decrease the potential of pregnancy and limit the spread of STIs, abstinence is the only way to actually prevent pregnancy and STI contraction. Spermicide should be inserted into the vagina 10 to 15 minutes prior to the client having intercourse, not after.

Semen analysis has been ordered for the partner of a client who has been unable to become pregnant. What instructions should the nurse provide to the partner? "Collect the sample after two consecutive days of ejaculating." "Keep the sample refrigerated to ensure the sperm survive." "Bring the sample to the lab immediately after you collect it." "If possible, collect the sample first thing in the morning."

"Bring the sample to the lab immediately after you collect it." Semen samples must be delivered to a lab no more than 30 minutes after collection. Storage in the refrigerator would violate this directive. The client should abstain from ejaculating for 3 to 5 days before collecting the sample. The semen does not need to be collected in the morning.

An 18-year-old female client who is sexually active asks the nurse for information on barrier contraceptives. Which statement is appropriate for the nurse to include in the response? "The use of a diaphragm is a good choice if you have frequent urinary tract infections." "A cervical cap is a barrier contraceptive that you can purchase over the counter." "A diaphragm must be inserted 1 hour prior to sexual intercourse." "Cervical caps are most effective when used along with a spermicidal agent."

"Cervical caps are most effective when used along with a spermicidal agent." The nurse would include information on using spermicidal agents along with barrier contraceptives. A cervical cap is a mechanical barrier contraceptive that interferes with conception by physically preventing sperm from fertilizing ova. Cervical caps cannot be purchased over the counter, because the client must be properly fitted for the device to work effectively. Frequent urinary tract infections are a contraindication to the use of diaphragms because diaphragm use can place pressure placed on the urinary tract. Diaphragms can be placed up to 18 hours before intercourse; however, 6 hours is the most commonly recommended time. Spermicide should not be placed more than 2 hours before intercourse.

A female client who has chosen the cervical cap as her method of contraception states that she knows how to use it. Which statement by the client would indicate to the nurse that the client does understand this method of contraception? "I will remove the cap immediately after every intercourse and reinsert it later." "This method will help protect me from getting sexually transmitted infections." "I do not need any follow-up procedures for this method." "I do not have any spermicidal allergies, so this method is OK for me."

"I do not have any spermicidal allergies, so this method is OK for me." Spermicidal allergies are contraindications for the cervical cap. The client should leave the cervical cap in place for at least six hours after intercourse. The cervical cap does not protect against sexually transmitted infections. The woman should have a follow-up Papanicolaou test 3 months after beginning to use the cap.

A client is 6 weeks' postpartum and preparing to receive a depot medroxyprogesterone acetate injection. Which statement by the client requires follow up by the nurse? "I will need to return every 3 months for a follow-up." "I need to be patient as it will take a few weeks before I can get pregnant again." "By increasing my activity and watching my diet I will better control my weight." "This does not affect my milk supply so I can continue to breastfeed."

"I need to be patient as it will take a few weeks before I can get pregnant again." The client needs to understand that this injection is to prevent pregnancy for up to 3 months. In addition, fertility is delayed after stopping the injections. The client statement, "I need to be patient as it will take a few weeks before I can get pregnant again," does not clearly indicate whether the client understands the length of action of the injection. Therefore, the nurse should follow up to confirm the client understands that, if pregnancy is desired within a year, another form of birth control might be more appropriate.

A female client has been trying to conceive for 3 months. She tells the nurse, "I just know something is wrong with me." Which response by the nurse is best? "It is time to talk to your health care provider about hormone testing." "Do you or your partner have a family history of subfertility?" "The problem can be with the man, woman, or both. We will explore all possibilities." "It can take up to 1 year of regular, unprotected intercourse to conceive."

"It can take up to 1 year of regular, unprotected intercourse to conceive." The nurse would first provide accurate information by informing the client that 3 months is not an adequate time frame to indicate a problem is present. Most couples conceive within 1 year when they have regular intercourse without the use of contraceptives. There is no reason to assess for infertility issues with the female or with the couple's families. It is true that subfertility issues can be related to the man, woman, or both; however, it is not appropriate to indicate there is concern by stating "we will explore all possibilities."

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

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

A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize? "Take the medication on an empty stomach." "Start taking the medication when you first get your period." "Add an aspirin to the regimen if you do not get relief right away." "It is normal for your bowel movements to be black."

"Start taking the medication when you first get your period." When taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, for dysmenorrhea, it is important for the woman to start therapy prophylactically and use sufficient doses to maximally suppress prostaglandin production. NSAIDs should be taken with food to prevent gastrointestinal upset. They should not be taken with aspirin because doing so can increase the risk of bleeding, which would be noted with black stools.

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

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

The nurse is caring for four female clients, all prescribed oral contraceptive pills (OCPs). The nurse will question giving an oral contraceptive pill to which client? 25-year-old client who has had three miscarriages and leads a sedentary lifestyle 30-year-old client who drinks a glass of wine daily and whose aunt had breast cancer 40-year-old client who has a history of asthma and a total cholesterol level of 170 mg/dl (4.40 mmol/L) 37-year-old client who has migraines with aura several times a week and smokes

37-year-old client who has migraines with aura several times a week and smokes The nurse would question giving an oral contraceptive to the 37-year-old client who has migraines with aura and smokes. This client has three risk factors (age, migraines with aura, and smokes) for complications such as deep vein thrombus formation, myocardial infarction, and cerebrovascular accident. The 25-year-old client should be counseled on becoming active. The 30-year-old client does not have any risk factors. The 40-year-old client should be monitored due to her age; however, her other factors are not contraindications. A total cholesterol level of 200 mg/dl (5.18 mmol/L) or less is considered normal.

A nurse is reading a journal article about premenstrual syndrome (PMS) and the millions of women affected by it during their reproductive years. The nurse would expect to find approximately what percentage of women meeting the American College of Obstetricians and Gynecologists criteria for PMS? 45% 55% 65% 75%

75% It is estimated that up to 75% of reproductive-age women experience premenstrual symptoms that meet the ACOG criteria for PMS and up to 8% meet the diagnostic criteria for premenstrual dysphoric disorder.

The client has heard of extended-cycle oral contraceptive regimens and desires more information. The nurse explains that these regimens consist of active combination pills, followed by placebo pills. How many days of active combination pills and placebo pills are contained in these regimens? 84 active; 7 placebo 70 active; 6 placebo 56 active; 5 placebo 42 active; 4 placebo

84 active; 7 placebo Research has confirmed that the extended use of active OC pills carries the same safety profile as the conventional 28-day regimens. The extended-cycle regimen consists of 84 consecutive days of active combination pills, followed by 7 days of placebo. The woman has four withdrawal-bleeding episodes a year.

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

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

A client needs additional information about the cervical mucus ovulation method after having read about it in a magazine. She asks the nurse about cervical changes during ovulation. What information should the nurse give the client? Cervical os is slightly closed. Cervical mucus is dry and thick. Cervix is high or deep in the vagina. Cervical mucus breaks when stretched.

Cervix is high or deep in the vagina. The nurse should explain that during ovulation, the cervix is high or deep in the vagina. The os is slightly open during ovulation. Under the influence of estrogen during ovulation, the cervical mucus is copious and slippery and can be stretched between two fingers without breaking. It becomes thick and dry after ovulation, under the influence of progesterone.

A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client? Record body temperature every night Record menses and time of intercourse Chart body temperature for at least a month Record body weight along with the temperature

Chart body temperature for at least a month The nurse should instruct the client to record her temperature each morning immediately upon awakening (at rest) using the same thermometer. The nurse should also instruct the client to record her menses, any events that would alter her temperature (e.g., infections, insomnia), and when she has intercourse. To maintain a basal body temperature chart, the client has to monitor her basal body temperature for several months. It is not necessary to record body weight along with the temperature.

A newly married couple is meeting with the nurse to discuss a temporary method of birth control that is both a natural form and does not employ birth control pills/devices, in keeping with their religious beliefs. Which method should the nurse point out will best meet their request to delay conception until they are ready? CycleBeads lactation amenorrhea method vasectomy coitus interruptus

CycleBeads CycleBeads is a natural fertility awareness method in which a woman uses a special circle of beads that helps her predict fertile days so that she can abstain from sex on those days. This method meets all of the requirements of the couple. Lactation amenorrhea is a natural method, but it would not apply in this situation, as the woman is not currently breastfeeding. Coitus interruptus is also a natural method, but it is not a fertility awareness method. Vasectomy is a surgical procedure that results in permanent sterility. As the couple would like to have children in the future, this method would not be appropriate.

The nurse is caring for a client at the ambulatory care clinic who questions the nurse for information about contraception. The client reports that she is not comfortable about using any barrier methods and would like the option of regaining fertility after a couple of years. Which method should the nurse suggest to this client? basal body temperature (BBT) coitus interruptus lactation amenorrhea method CycleBeads or medroxyprogesterone injection

CycleBeads or medroxyprogesterone injection The best option for a client who is not well educated would be the Standard Days Method with CycleBeads, as the 32 color-coded CycleBeads are easy to use and understand. An injection of medroxyprogesterone would also suit this client, as it works by suppressing ovulation and the production of follicle stimulating hormone and luteinizing hormone by the pituitary gland and prevents pregnancy for 3 months at a time. BBT requires the client to take and chart her body temperature; this may be difficult for the client to follow. Coitus interruptus is a method in which the man controls his ejaculation and ejaculates outside the vagina; this suggests that the client rely solely on the cooperation and judgment of her spouse. The lactation amenorrhea method works as a temporary method of contraception only for breastfeeding mothers.

A community health nurse is preparing a presentation for a health fair on the topics of planning for a pregnancy. Which major goal has the nurse determined should be accomplished with this presentation? Ensure women are using the correct contraceptive method. Ensure couples understand genetic risks. Provide one-on-one counseling. Decrease the number of unwanted pregnancies.

Decrease the number of unwanted pregnancies. Preconception counseling with general health care is a health promotion activity to help prevent unwanted pregnancies. The nurse will be responsible for presenting the basic information to everyone. In this environment it would not be appropriate for the nurse to provide one-on-one counseling due to privacy concerns. The nurse could present various risks but it would be beyond the scope of this event to ensure every participant understands each point.

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

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

A client has opted to use an intrauterine device (IUD) for contraception. About which effect of the device on monthly periods should the nurse inform the client? Periods become lighter. Periods become more painful. Periods become longer. Periods reduce in number.

Periods become lighter. The nurse should inform the client that IUDs cause monthly periods to become lighter, shorter, and less painful. Monthly periods reduce in number with use of oral contraceptives, but not with use of IUDs.

A client is requesting information on the various available contraceptives. When explaining a vaginal spermicide, which information should the nurse prioritize? Wash with clean water and soap after intercourse. Insert the product by applicator in the vagina prior to intercourse. Apply the spermicide directly to the glans penis to kill the sperm when they exit the penis. Leave the product in place for 24 hours after intercourse.

Insert the product by applicator in the vagina prior to intercourse. Vaginal spermicides provide a physical barrier that prevents sperm penetration and a chemical barrier that kills sperm. It is designed to be inserted vaginally immediately before or within a few hours before sexual intercourse. Hygiene is always important and is unrelated to the use of spermicides. Applying the spermicide to the penis would be ineffective as it would rub off. The product is immediately effective and can be removed right after intercourse.

What is an advantage of a cervical cap over a diaphragm? No initial fitting is required. It can be left in place longer. It needs no spermicidal jelly. It does not need to be refitted after pregnancy.

It can be left in place longer. Because a cervical cap does not press against the sides of the vagina, possibly interfering with blood supply, it can be left in place longer.

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

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

The nurse is preparing to meet with a couple who have requested counseling concerning family planning. The nurse will prioritize which topics for discussion? Ensuring the couple is legally married Ensuring the correct time frame is followed Possible genetic abnormalities Preventing STIs

Possible genetic abnormalities Family planning consists of two complementary components: planning pregnancy and preventing pregnancy. The nurse may be involved with teaching the families how to avoid unwanted pregnancies, bring about wanted births, and control the intervals between births. Discussing potential genetic anomalies would be involved as the family prepares for children. It would not be proper for the nurse to ignore this couple based on their marriage status. The time frame would be determined by the couple and is flexible. Preventing STIs would also not be a focus of this session.

A nurse is planning care for a client and her husband recently diagnosed with multiple sclerosis and wanting to prevent pregnancy for now. What is the most appropriate nursing diagnosis for this couple? Readiness for enhanced knowledge regarding contraception options Decisional conflict regarding choice of birth control because of health concerns Altered sexuality pattern related to fear of pregnancy Risk for ineffective health maintenance related to lack of knowledge

Readiness for enhanced knowledge regarding contraception options The nurse should recognize that the couple is ready for enhanced knowledge regarding contraceptive options. By providing education materials on the options available the clients can select the best option for them.

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

Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule. A healthy lifestyle contributes to a general sense of well-being. Encourage regular exercise, reduction or elimination of caffeine and alcohol, and adequate and regular sleep.

The nurse has been working with a subfertile couple through the process of determining their best plan of action to conceive a child. Which action should the nurse prioritize to provide emotional support to this couple? Speak only with both partners present so they will feel more comfortable. Speak separately with each partner so both will feel more free to talk. Speak both separately and together with both partners. Only speak with the woman, who is the client.

Speak both separately and together with both partners. Talking with both partners together may be advantageous, because this may make them feel more comfortable to discuss their problem. On the other hand it is important to spend time alone with each partner, in case there is something one person wants to discuss privately. Both partners are the client in this case.

When caring for a client with reproductive issues, the nurse is required to clear up misconceptions. This enables new learning to take hold and a better client response to whichever methods are explored and ultimately selected. Which misconceptions will the nurse needs to clear up? Select all that apply. Breastfeeding does not protect against pregnancy. Taking birth control pills protects against sexually transmitted infections (STIs). Douching after sex will prevent pregnancy. Pregnancy can occur during menses. Irregular menstruation prevents pregnancy.

Taking birth control pills protects against sexually transmitted infections (STIs). Douching after sex will prevent pregnancy. Irregular menstruation prevents pregnancy. The nurse needs to clear up misconceptions by explaining to clients that taking birth control pills does not protect against STIs and that irregular menstruation or douching after sex does not prevent pregnancy. The nurse also needs to confirm that breastfeeding does not protect against pregnancy and that pregnancy can occur during menses.

A nurse is teaching a female client about fertility awareness as a method of contraception. The nurse should mention to the client that this method relies on which assumption? Sperm can live up to 24 hours after intercourse. The "unsafe period" is approximately 6 days. The exact time of ovulation can be determined. The "safe period" is 3 days after ovulation.

The "unsafe period" is approximately 6 days. The nurse should explain to the client that the fertility awareness method relies on the assumption that the "unsafe period" is approximately 6 days—3 days before and 3 days after ovulation. The method also assumes that sperm can live up to 5 days, not just 24 hours after intercourse. An ovum lives up to 24 hours after being released from the ovary. The exact time of ovulation cannot be determined, so 2 to 3 days are added to the beginning and end to avoid pregnancy.

A healthy 28-year-old female client is planning a pregnancy with the support of a female partner. What does the nurse anticipate will be the first method of assisting this client to achieve a pregnancy? artificial insemination intracytoplasmic sperm injection (ICSI) gestational carrier in vitro fertilization (IVF)

artificial insemination For a healthy female client with no known challenges with fertility, artificial insemination with donor sperm is the most affordable and least invasive approach to achieving a pregnancy. The other methods listed will be considered if artificial insemination is not effective.

The public health nurse is teaching a community class of couples on fertility awareness-based methods. The nurse determines that additional teaching is needed when one of the couples states that they will be using which method? coitus interruptus method cervical mucus ovulation method basal body temperature method symptothermal method

coitus interruptus method Fertility awareness refers to any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature (BBT) method, the symptothermal method, standard days method, and 2-day method. Coitus interruptus or withdrawal is not considered a fertility awareness based method.

A nurse is conducting a class for a group of young adults at the health clinic about contraceptive options. The nurse determines that the teaching was successful when the group identifies which type as protective against sexually transmitted infections? condom intrauterine system diaphragm with spermicide contraceptive patch

condom Only the condom provides protection against sexually transmitted infections. Intrauterine system, diaphragm, and contraceptive patch offer no protection.

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

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

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

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

The nurse assess a 28-year-old client who presented to the clinic with concerns about increased body hair and irregular menstrual cycles (above). What diagnostic testing does the nurse anticipate the provider will prescribe? Select all that apply. fasting blood glucose lipid profile hysterosalpingogram clomiphene citrate challenge test potassium blood level

fasting blood glucose lipid profile This client is presenting with typical signs of polycystic ovary syndrome (PCOS), including increased body weight, irregular (and often anovulatory) menstrual cycles, and increased body hair. Because this disorder is commonly associated with metabolic syndrome, the nurse will anticipate orders for fasting blood glucose and lipid profile. A hysterosalpingogram is not indicated; there is no indication that this client is experiencing infertility or desiring pregnancy. Clomiphene is often used to stimulate ovulation in clients with PCOS, but it is not indicated prior to further assessment and diagnosis. Potassium blood level is not required for a diagnosis of PCOS, but if the PCOS is treated with spironolactone the client would require potassium level monitoring.

During an education session, the nurse describes the body system changes that occur during perimenopause. What common change(s) does the nurse include? Select all that apply. hot flashes increased abdominal fat moist, supple skin vaginal dryness decreased bone density

hot flashes increased abdominal fat vaginal dryness decreased bone density Perimenopause may be associated with hot flashes, increased abdominal fat, vaginal dryness, decreased bone density, dry/thinning skin, and increased waist size.

A client is to be examined for the presence and extent of endometriosis. For which test should the nurse prepare the client? tissue biopsy hysterosalpingogram clomiphene citrate challenge test laparoscopy

laparoscopy The nurse should prepare the client for a laparoscopy to obtain a definitive diagnosis; laparoscopy allows for direct visualization of the internal organs and helps confirm the diagnosis. A hysterosalpingogram assesses tubal patency, and a clomiphene citrate challenge test determines ovarian function; these tests are not used to determine the extent of endometriosis.

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

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

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? semen analysis, ovulation monitoring, and tubal patency assessment semen analysis, urinalysis, and ovulation monitoring serologic test for syphilis, semen analysis, and tubal patency assessment pelvic sonogram, ovulation monitoring, and semen analysis

semen analysis, ovulation monitoring, and tubal patency assessment Only three tests are commonly used to test fertility: semen analysis in the male and ovulation monitoring and tubal patency assessment in the female. Additional testing may be performed both on the man and the woman, which may include urinalysis, serologic test for syphilis, and pelvic sonogram, but these are not the primary tests used.

When using the contraceptive patch, a client should understand that it: should be applied to the breasts, hips, or back. should be covered when swimming in a pool because of chlorine's effect on the adhesive. is immediately effective after application. should be applied to the abdomen, buttocks, or back.

should be applied to the abdomen, buttocks, or back. 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 nurse is assessing a 26-year-old married female client for use of oral contraceptive pills (OCPs). Which findings in her health history would suggest that natural family planning may be a better option? Select all that apply. abortion (elective termination of pregnancy) at age 18 menses at age 11 smokes 1 pack per day blood pressure 138/88 mm Hg migraine headaches

smokes 1 pack per day blood pressure 138/88 mm Hg migraine headaches The significant assessment findings within the client's history that would suggest that natural family planning would be a better option would be the history of smoking, increased blood pressure, and migraine headaches. Both smoking and hypertension are contraindicated with the use of oral contraceptive pills (OCPs). The use of hormones in OCPs can increase migraine headaches, so this should be a concern for the nurse.

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

suppresses follicle-stimulating hormone (FSH) Estrogen has a direct effect on the pituitary gland suppressing FSH; progesterone increases permeability of cervical mucus and endometrial proliferation.

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

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

Which finding concerns the nurse when caring for a subfertile male client? exercises 30 minutes daily, 7 days per week works as a long-distance truck driver history of smoking marijuana 4 years ago having intercourse with partner every 3 to 4 days

works as a long-distance truck driver Actions that increase scrotal heat, such as working at desk jobs or driving a great deal every day, may produce lower sperm counts compared with men whose occupations allow them to be ambulatory at least part of each day. This finding would concern the nurse. Regular exercise of 30 minutes daily would not increase scrotal heat enough to cause concern. A history of marijuana use would not be of concern, only current use. Intercourse should be spaced out to every 2 to 4 days to allow for sperm production to mature. Daily intercourse is not advised for the couple trying to conceive.