Ricci Chapter 4: Common Reproductive Issues

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?

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.

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?

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.

Which definition best explains the term "subfertility/infertility"?

failure to achieve pregnancy in 1 year of unprotected intercourse Infertility is the failure to achieve conception after 1 year of unprotected intercourse.

The school nurse is counseling a sexually active 16-year-old adolescent about the various forms of contraception. She is afraid of getting pregnant or contracting a sexually transmitted infection because her boyfriend refuses to use a condom. In answering the client's questions as to which option will be best suit her needs, which form should the nurse recommend?

female condom The female condom would be the best choice for this client, as it provides protection against both STIs and conception. A tubal ligation would not be recommended for a 16-year-old girl, as it is a permanent measure and she may decide to have children in the future. Neither an oral contraceptive nor coitus interruptus would provide protection against STIs.

The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort?

hysterectomy If the client does not respond to medical therapy, surgical intervention might include dilatation and curettage (D&C), endometrial ablation, uterine artery embolization, or hysterectomy. Of these, hysterectomy is considered a last resort.

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 Azoospermia 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.

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 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.

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?

"Bring the sample to the lab immediately after your 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.

Which question would be most appropriate for a nurse to ask a client to assist in establishing a nursing diagnosis of Deficient knowledge related to measure to promote fertility?

"How often does you and your partner engage in intercourse?" An initial question that will gauge the knowledge level of the client related to reproduction is how frequently she engages in intercourse.

The nurse has provided information to a client about oral contraceptive pills (OCPs). Which statement by the client would indicate a need for further education?

"Some oral contraceptive pills protect against STIs" Oral contraceptive pills (OCPs) need to be taken on a daily basis to prevent breakthrough ovulation. Oral contraceptive pills do not protect against STIs, and clients still need to use STI protection such as condoms. In addition to preventing pregnancy, hormonal contraceptives have many health benefits, including a reduction in risk of ovarian cancer and endometrial cancer, reducing symptoms of premenstrual discomforts, decreasing blood loss and anemia, reducing symptoms of endometriosis, and many other benefits.

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?

before penile-vulvar contact 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.

The nurse was teaching a college student how to properly take the prescribed combination oral contraceptive (COC). The nurse determines the session is successful when the client correctly chooses which instruction to follow when taking the OCP?

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 couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply.

semen analysis ovulation monitoring tubal patency Today, a subfertility investigation usually is limited to three assessments: semen analysis, ovulation monitoring, and tubal patency.

A nurse is receiving a client from the postanesthesia unit to the recovery unit at the ambulatory surgery center. The client just had a laparoscopic tubal ligation. Which is the nurse's priority assessment?

bleeding The nurse's priority assessment is for bleeding from the surgical sites or vagina, which can be an indication of a possible complication of the procedure. Pain is expected following a surgical procedure and will be a concern for the nurse.

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?

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 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?

invitro 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.

A young couple is having difficulty getting pregnant. The nurse is preparing the couple for the initial tests to determine their fertility. When asked by the couple why they need to start with a sperm analysis, what will be the nurse's best response?

sperm analysis is one of the easiest tests to complete Because sperm analysis is noninvasive, it is one of the easiest (and most cost-effective) tests to complete. There is no bias in male vs. female with regard to being the cause of infertility.

A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client?

the vas deferens The two vas deferens or ductus deferentia are ligated and cut in the male sterilization procedure, called a vasectomy. The epididymis serves as a site for sperm to mature and be stored until ejaculation occurs. The ejaculatory ducts empty into the urethra and receive secretions from the prostate gland to make up semen. The scrotum is a sac-like structure that sits behind the penis and houses the testicles.

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus?

when it is thin, watery, and copious The cervical mucus method relies on the changes that occur naturally with ovulation. Before ovulation, cervical mucus is thick and does not stretch when pulled. With ovulation, the mucus becomes thin, copious, watery, transparent, and stretchy.

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 and 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.

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 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.

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?

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.

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client?

checking the strings is recommended following insertion The nurse should instruct the client to check the strings/threads regularly to make sure that the IUD is in place. Current recommendations are to check the strings monthly after insertion, but some clients may be instructed to check less frequently after the first 3 months following insertion because expulsion of the IUD is less common after that time. An IUD does not protect against STIs, and the insertion procedure may involve mild to moderate cramping pain; however, the client should not expect to have continuous cramping pain following insertion.

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?

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.

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 minimal 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?

the could can plan 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.

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?

"Cervical caps are most affective when used along with a spermidical 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 is 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 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?

"I will be able to have my third child in about a year from now" 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 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?

"Start taking your medication when you 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 woman has opted to use medroxyprogesterone injections for birth control. The client receives the first injection today. The nurse instructs the woman to return to the clinic in how many months for the next injection?

3 The medroxyprogesterone injection is given intramuscularly every 3 months.

The nurse is caring for four female clients, all prescribed oral contraceptive pills. The nurse will question giving an oral contraceptive pill to which client?

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 accidents. 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 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.

Guilt related to the lack of conception Anger toward others who have conceived Fear of the possible outcome of the testing 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.

After assessing a client, a nurse determines that an IUD as a method of contraceptive would be contraindicated based on a history of which finding?

abnormal uterine shape Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape (the device might perforate the uterine wall). The copper IUD use also is not advised for a woman with severe dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding) because use may increase the incidence of these conditions. Because use of a copper IUD can cause heavier than usual menstrual flow, a woman with anemia also may not be considered a good candidate for a copper IUD. The other findings are not contraindications.

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

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 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 teaching a young couple who desire to start their family the various methods for determining fertility. After discovering the woman regularly travels internationally for work, deals with a lot of job anxiety, and frequently uses an electric blanket at home, the nurse will discourage the use of which method?

basal body temperature method BBT is a method where the body temperature should be checked and recorded first thing in the morning, immediately after waking and before getting out of bed. It is important for the patient to maintain a normal bedtime routine. Use of an electric blanket, stress, and anxiety can cause a false elevation in the BBT. The calendar method would depend upon her schedule. Cervical mucus and symptothermal methods would be viable options.

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?

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 is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that she needs further teaching?

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:

causes 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.

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

change in the cervical mucus 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.

The estrogen content in the contraceptive pill performs which action?

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

The nurse is conducting a well-visit physical assessment on a 29-year-old female. The nurse determines the client is probably ovulating based on which condition of the cervical mucus?

thin, slippery, stretchy The mucus at the time of ovulation is thin, slippery, and stretchy to allow for the passage of sperm into the uterus. This is called spinnbarkeit fiber. If the mucus is too thick, it will inhibit fertilization. Before ovulation, the mucus is thick and does not stretch easily.

The nurse is conducting a routine well-visit on a 43-year-old client who is concerned about developing breast cancer, although no family members have experienced it. What is the best advice for this client at this time?

know how her breasts normally look and feel The ACS recommends that each woman know how her breasts normally look and feel, and if she finds changes, she should immediately report them to a health care provider. Discharge from the nipple is not necessarily related to cancer. For women with an average risk for breast cancer, yearly mammograms should start at age 45 and can change to every 2 years beginning at age 55. Women who are at a higher risk for breast cancer due to family history or other reasons may need to begin screening earlier and/or more often.

The nurse is caring for a woman who had a dilatation and curettage (D&C) 1 hour prior. What assessment finding would alert the nurse to immediately intervene?

pulse rate of 122 beats/min The nurse would further assess the client for a hemorrhage when noting an elevated pulse rate. One of the risk following a D&C is vaginal hemorrhage. The client's blood pressure would be low, not high, if the client were hemorrhaging vaginally. The client's temperature is normal at 98.6° F (37° C) and is an expected finding within an hour of the procedure. Abdominal cramping is an expected finding.

A couple is considering vasectomy as a contraception option. However, the husband is nervous about how such a procedure would affect his sexual functioning. Which information should the nurse mention to the man?

the male will still have full erection capacity Some men resist the concept of vasectomy because they are not sufficiently aware of their anatomy to know exactly what the procedure will involve. They can be assured vasectomy does not interfere with the production of sperm; the testes continue to produce sperm as always, but the sperm simply do not pass beyond the plugged vas deferens and are absorbed at that point. The man will still have full erection capacity and continue to produce testosterone. Because he also continues to form seminal fluid, he will ejaculate seminal fluid; it will just not contain sperm.

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

A nurse is helping a couple choose a contraception method that is right for them. Which is the least likely factor the nurse should consider?

the popularity of the method among the couples friends Important things to consider when helping a couple to choose a method that will be right for them include the following: personal values, ability to use a method correctly, whether the method will affect sexual enjoyment, financial factors, whether a couple's relationship is short-term or long-term, prior experiences with contraception, and future plans. The popularity of the method is the least likely factor the nurse should consider.

A nurse is counseling women on birth control choices. Which woman is the best candidate for an IUD?

a women 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 young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend?

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.

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?

"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.

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 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?

"I will call the healthcare 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 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 could 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."

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 my 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 52-year-old client reports to the nurse the recent onset of hot flashes, fatigue, and vaginal dryness. Which response by the nurse is most appropriate?

"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.

A client is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that she needs further teaching?

"The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." IVF is a procedure used when the woman has absent or blocked fallopian tubes, when the man 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 educates a 15-year-old female client on ways to prevent pregnancy. Which statement will the nurse include in the teaching?

"The use of a condom is 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.

A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions?

"They will place a catheter in my uterus and use an ultrasound to see what the problem is" A nurse would recognize that this procedure is a sonographic procedure that includes the insertion of a contrast agent into the uterus and fallopian tubes. This procedure can be used as both diagnostic and therapeutic to break up adhesion within the fallopian tubes.

A client states she has purchased home-use ovulation strips to help her know when she is ovulating. Which response by the nurse is most appropriate?

"You can also test your vaginal discharge if you are ovulating" The appropriate statement for the nurse to make is regarding testing vaginal or cervical discharge (spinnbarkeit test). This testing and basal body temperature monitoring are free methods clients can use at home to test for ovulation. The home-use ovulation kit monitors luteinizing hormone (LH) levels in a urine sample. The home-use kit monitors for a surge in LH that would indicate ovulation is getting ready to occur. They are typically effective; however, they can be expensive to use repeatedly. Although being tested in the clinic would be most accurate, this is not feasible for most clients financially nor easy to fit into daily schedules. The nurse would not provide false assurance that usage will lead to a quick pregnancy as other factors could be present.

The nurse working in a free health clinic assesses a 17-year-old client interested in contraceptives. Which statement by the client would indicate that female or male condoms would be the appropriate recommendation? la

"last year I was diagnosed with HPV" The client has already contracted HPV; to prevent further spread of it—or contracting other STIs—the nurse should recommend the client use male or female condoms.

The nurse is instructing a client with dysmenorrhea on how to manage her symptoms. Which suggestions should the nurse include in the teaching plan? Select all that apply.

Increase water consumption. Use heating pads or take warm baths. Increase exercise and physical activity. When instructing a client with dysmenorrhea on how to manage her symptoms, the nurse should ask her to increase water consumption, use heating pads or take warm baths, and increase exercise and physical activity. Water consumption serves as a natural diuretic, heating pads or warm baths help increase comfort, and exercise increases endorphins and suppresses prostaglandin release. The nurse should also tell the client to limit salty foods to prevent fluid retention during menstruation and to keep legs elevated while lying down because this helps increase comfort.

Which statement best explains the action of the lactational amenorrhea method (LAM) of fertility control?

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.

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?

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 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:

copper 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 nurse is preparing a presentation for a local community women's group about menopause. When describing the body system changes that occur, the nurse would include which changes? Select all that apply.

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

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 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.

A young woman comes to the free clinic asking for oral contraceptive pills. Which factor best indicates that another type of contraception would be better for this client?

history of non-compliance with medications If a woman has a history of poor compliance with medication, it might not be realistic for her to plan on taking an oral contraceptive pill every day.

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

A client is requesting information on the various available contraceptives. When explaining a vaginal spermicide, which information should the nurse prioritize?

inset the product via applicator 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.

A nurse is providing a client with information on hormonal contraception. Which could the nurse use as an example of hormonal contraception?

medroxyprogesterone The nurse should inform the client that medroxyprogesterone is a hormonal contraceptive. Sildenafil and tadalafil are medications designed to induce erection. Mifepristone causes abortion (elective termination of pregnancy). They do not act as hormonal contraceptives.

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 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.

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?

oral contraceptive pills (OCP) Oral contraceptive pills 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.

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 contraceptives (OCP) 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.

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 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 scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs?

priapism Priapism (erection lasting longer than 4 hours) is a side effect of tadalafil that warrants notifying a health care provider immediately.

A couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility?

secondary infertility There are two main types of infertility: primary and secondary. A couple who has never been able to conceive has primary infertility, whereas a couple who has been able to conceive in the past but is currently unable to do so has secondary infertility.

A woman is diagnosed with premenstrual dysphoric disorder. To address the woman's behavioral symptoms, which class of agents would the nurse anticipate needing to be addressed in the woman's teaching plan?

selective serotonin reuptake inhibitors (SSRIs) Although diuretics, NSAIDs, and vitamin supplements may be used as part of the treatment plan for premenstrual dysphoric disorder, SSRIs are commonly prescribed to address the behavioral and mood symptoms of this condition.

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply.

semen monitoring tubal patency ovulation monitoring Today, a subfertility investigation usually is limited to three assessments: semen analysis, ovulation monitoring, and tubal patency.

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 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.

Which information is important for a woman to understand before undergoing a scheduled tubal ligation?

she must think of the procedure as irreversible Sterilization by fallopian tube obstruction does not alter menstrual symptoms or flow. Ectopic pregnancy could result if it is done following ovulation; reversing the process is difficult.

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

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.

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

sperm analysis is one of the easiest tests to complete Because sperm analysis is noninvasive, it is one of the easiest tests (and therefore most cost-effective) to complete.

A 30-year-old client would like to try using basal body temperature (BBT) as a fertility awareness method. Which instruction should the nurse provide the client?

take temperature before rising and record it on the chart The client should be instructed to take her temperature before rising and record it on a chart. If using this method by itself, the client should avoid unprotected intercourse until the BBT has been elevated for 3 days. The client should be informed that other fertility awareness methods should be used along with BBT for better results. The oral method is better suited than the axillary method for taking the temperature in this case.

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?

three das 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.

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?

three days after she records a light 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).

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?

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.