Chapter 11 Special Reproductive Concerns: Infertility and Genetics

A client and her husband have contacted their physician about fertility problems. At the initial visit, the nurse instructs them about the infertility workup. Which statement by the client would indicate that the instructions have been successful? 1. "The first test that we need to schedule is a semen analysis." 2. "We need to schedule the Pap smear test first." 3. "We need to schedule an appointment with the social worker in order to adopt." 4. "We need to schedule an appointment with a marriage counselor."

Answer: 1 Explanation: 1. A semen analysis is one of the first diagnostic tests, prior to doing invasive procedures.

A couple is requesting fertility counseling. The nurse practitioner has identified the factors listed below in the woman's health history, and knows which of them could be contributing to the couple's infertility? 1. The client is 38 years old. 2. The client was 13 years old when she started her menses. 3. The client works as a dental hygienist 3 days a week. 4. The client jogs 2 miles a day.

Answer: 1 Explanation: 1. As the eggs of older women age, their fertility is reduced.

What type of testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG? 1. Chlamydia trachomatis IgG antibody testing 2. Preimplantation genetic testing 3. Noninvasive prenatal testing (NIPT) 4. DNA testing

Answer: 1 Explanation: 1. Chlamydia trachomatis IgG antibody testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG.

A pregnant client asks the nurse, "What is this "knuckle test" that is supposed to tell whether my baby has a genetic problem?" What does the nurse correctly explain? 1. "In the first trimester, the nuchal translucency measurement is added to improve the detection rate for Down syndrome and trisomy 18." 2. "You will need to ask the physician for an explanation." 3. "It tests for hemophilia A or B." 4. "It tests for Duchenne muscular dystrophy."

Answer: 1 Explanation: 1. Screening tests, such as nuchal translucency ultrasound are designed to gather information about the risk that the pregnancy could have chromosome abnormalities or open spina bifida

The nurse is talking with a couple who have been trying to get pregnant for 5 years. They are now at the fertility clinic seeking help. The nurse assesses their emotional responses as part of the workup. Which responses would the nurse expect to hear? 1. Experiencing a sense of loss of status 2. Feelings of failure because they cannot make a baby 3. Healthy relationship with healthcare partners 4. Stress on the marital and sexual relationship 5. Feelings of frustration

Answer: 1, 2, 4, 5 Explanation: 1. The couple may experience feelings of loss of status and ambiguity as a couple. 2. Feelings of failure are common. 4. The couple may experience stress on the marital and sexual relationship. 5. Tests and treatments may heighten feelings of frustration or anger between partners.

The clinic nurse assesses a newborn that is not progressing as expected. Genetic tests are ordered. The nurse explains to the parents that the laboratory tests to be done include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Chromosome analysis 2. Complete blood count 3. Phenylketonuria 4. Enzyme assay 5. Antibody titers

Answer: 1, 4, 5 Explanation: 1. Laboratory analysis includes chromosome analysis. 4. Laboratory analysis includes enzyme assay for inborn errors of metabolism. 5. Laboratory analysis includes antibody titers for infectious teratogens.

A client is to receive fertility drugs prior to in vitro fertilization. What is the expected action of this medication? 1. Prolonging of the luteal phase 2. Stimulation of ovulation 3. Suppression of menstruation 4. Promotion of cervical mucus production

Answer: 2 Explanation: 2. In IVF, a woman's ovaries are stimulated by a combination of medications, one or more oocytes are aspirated from her ovaries and fertilized in the laboratory, and then they are placed into her uterus after normal embryo development has begun.

A couple who have sought fertility counseling have been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which condition occurs? 1. The vas deferens is ligated. 2. Male obesity is present. 3. The prostate gland is enlarged. 4. The flagella are segmented.

Answer: 2 Explanation: 2. Male obesity is associated with poor spermatogenesis and increased amount of time to conception.

The nurse is reviewing assessment data from several different male clients. Which one should receive information about causes of infertility? 1. Circumcised client 2. Client with a history of premature ejaculation 3. Client with a history of measles at age 12 4. Client employed as an engineer

Answer: 2 Explanation: 2. Premature ejaculation is a possible cause of infertility.

An infertile couple confides in the nurse at the infertility clinic that they feel overwhelmed with the decisions facing them. Which nursing strategy would be most appropriate? 1. Refer them to a marriage counselor. 2. Provide them with information and instructions throughout the diagnostic and therapeutic process. 3. Express concern and caring. 4. Inquire about the names they have chosen for their baby.

Answer: 2 Explanation: 2. The nurse can provide comfort to couples by offering a sympathetic ear, a nonjudgmental approach, and appropriate information and instruction throughout the diagnostic and therapeutic processes.

A client calls the urologist's office to receive instructions about semen analysis. What does the nurse instruct the client to do? 1. Avoid sexual intercourse 24 hours prior to obtaining a specimen. 2. Use a latex condom to collect the specimen. 3. Expect that a repeat test might be required. 4. Expect a small sample.

Answer: 3 Explanation: 3. A repeat semen analysis might be required to adequately assess the man's fertility potential.

A 58-year-old father and a 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease and low-set ears on the newborn. The nurse plans to counsel the couple about which chromosomal abnormality? 1. Trisomy 13 2. Trisomy 18 3. Trisomy 21 4. Trisomy 26

Answer: 3 Explanation: 3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).

The nurse is reviewing preconception questionnaires in charts. Which couple are the most likely candidates for preconceptual genetic counseling? 1. Wife is 30 years old, husband is 31 years old 2. Wife and husband are both 29 years old, first baby for husband, wife has a normal 4-year-old 3. Wife's family has a history of hemophilia 4. Single 32-year-old woman is using donor sperm

Answer: 3 Explanation: 3. For families in which the woman is a known or possible carrier of an X-linked disorder, such as hemophilia, the risk of having an affected male fetus is 25%.

The couple at 12 weeks' gestation has been told that their fetus has sickle cell disease. Which statement by the couple indicates that they are adequately coping? 1. "We knew we were both carriers of sickle cell. We shouldn't have tried to have a baby." 2. "If we had been healthier when we conceived, our baby wouldn't have this disease now." 3. "Taking vitamins before we got pregnant would have prevented this from happening." 4. "The doctor told us there was a 25% chance that our baby would have sickle disease."

Answer: 4 Explanation: 4. A true statement indicates coping. When both parents are carriers of an autosomal recessive disease, there is a 25% risk for each pregnancy that the fetus will be affected.

A newborn has been diagnosed with a disorder that occurs through an autosomal recessive inheritance pattern. The parents ask the nurse, "Which of us passed on the gene that caused the disorder?" Which answer should the nurse tell them? 1. The female 2. The male 3. Neither 4. Both

Answer: 4 Explanation: 4. An affected individual can have clinically normal parents, but both parents are generally carriers of the abnormal gene.

A couple is seeking advice regarding what they can do to increase the chances of becoming pregnant. What recommendation can the nurse give to the couple? 1. The couple could use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The woman should be on top during intercourse.

Answer: 3 Explanation: 3. This is the correct answer, as douching can alter sperm mobility.

A client scheduled a laparoscopy. After the procedure, what does the nurse instruct the client to do? 1. Stay on bed rest for 48 hours. 2. Expect to have shoulder and arm pain. 3. Purchase a rectal tube to relieve the gas. 4. Lie on her back to relieve the gas pain after the procedure.

Answer: 4 Explanation: 4. Assuming a supine position may help relieve residual shoulder and chest discomfort caused by any remaining gas.

During the initial visit with the nurse at the fertility clinic, the client asks what effect cigarette smoking has on the ability to conceive. What is the nurse's best response? 1. "Smoking has no effect." 2. "Only if you smoke more than one pack a day will you experience difficulty." 3. "After your first semen analysis, we will determine whether there will be any difficulty." 4. "Smoking can affect the quantity of sperm."

Answer: 4 Explanation: 4. The quantity and quality of male sperm are affected by cigarette smoking.

The nurse is teaching an infertile couple about the causes of infertility. The nurse tells them that infertility can be caused by which of the following? 1. Immunological responses 2. Congenital anomalies 3. Patent fallopian tubes 4. Hypothyroidism 5. Favorable cervical mucus

Answer: 1, 2, 4 Explanation: 1. Immunological responses, such as antisperm antibodies, can cause infertility. 2. Congenital anomalies, such as a septate uterus, can cause infertility. 4. Hypothyroidism is a cause of infertility.

The nurse in the OB-GYN clinic counsels a couple that in autosomal dominant inheritance, which of the following occur? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. An affected individual might have an affected parent. 2. The affected individual has a 75% chance of passing on the abnormality. 3. Males and females are equally affected by the gene. 4. A father can pass the defective gene to a son. 5. There are no variances in the genetic pattern for autosomal dominant disorders.

Answer: 1, 3, 4 Explanation: 1. The family pedigree usually shows multiple generations having the disorder. 3. Males and females are equally affected in autosomal dominant disorders. 4. In autosomal dominant disorders, the father can pass the defective gene to a son.

A couple is at the clinic for preconceptual counseling. Both parents are 40 years old. The nurse knows that the education session has been successful when the wife makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We are at low risk for having a baby with Down syndrome." 2. "Our children are more likely to have genetic defects." 3. "Children born to parents this age have sex-linked disorders." 4. "The tests for genetic defects can be done early in pregnancy." 5. "It will be almost impossible for us to conceive a child."

Answer: 2, 4 Explanation: 2. Women 35 or older are at greater risk for having children with chromosome abnormalities. 4. Genetic testing such as amniocentesis and chorionic villus sampling are done in the first trimester.

The OB-GYN nurse is assessing a pregnant client, and recognizes genetic amniocentesis will be indicated. The nurse makes this conclusion because the indications for genetic amniocentesis include which of the following? 1. Maternal age under 35 2. Fetus with no abnormalities on ultrasound 3. One child with a chromosome abnormality 4. A family history of neural tube defects 5. Both parents with an abnormal chromosome

Answer: 3, 4, 5 Explanation: 3. Couples who have had a child with trisomy 21, 18, or 13 have approximately a 1% risk or their age-related risk, whichever is higher, of a future child having a chromosome abnormality. 4. Family history of neural tube defects is an indication for genetic amniocentesis. 5. If both parents carry an autosomal recessive disease, they have a 25% chance with each pregnancy that the fetus will be affected.

Which couples may benefit from prenatal diagnosis? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Couples including women under the age of 35 2. Couples with an unbalanced translocation 3. Couples with a family history of known or suspected single-gene disorder 4. Couples including women with a teratogenic risk secondary to an exposure or maternal health condition 5. Family history of birth defects and/or intellectual disability

Answer: 3, 4, 5 Explanation: 3. Couples with a family history of known or suspected single-gene disorder (e.g., cystic fibrosis, hemophilia A or B, Duchenne muscular dystrophy) may benefit from prenatal diagnosis. 4. Women with a teratogenic risk secondary to an exposure or maternal health condition (e.g., diabetes, seizure disorder) may benefit from prenatal diagnosis. 5. Family history of birth defects and/or intellectual disability (mental retardation) (e.g., neural tube defects, congenital heart disease, cleft lip and/or palate) may benefit from prenatal diagnosis.

A nurse working with couples undergoing genetic testing recognizes which of the following as nursing responsibilities? 1. Allowing the family to interact with the genetic counselor without interference 2. Giving information about support groups when asked 3. Identifying families at risk for genetic problems 4. Aiding families in coping with the crisis 5. Ensuring continuity of nursing care to the family

Answer: 3, 4, 5 Explanation: 3. The nurse has a responsibility to identify families at risk for genetic problems. 4. The nurse should aid families in coping. 5. The nurse needs to ensure continuity of care to the family.

33) A nurse counsels a couple on sex-linked disorders. Both the man and the woman are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse's best response? 1. "If you have a daughter, she will not be affected." 2. "Your son will be affected because the father has the disorder." 3. "There is a 25% chance that your son will have the disorder because the mother has the disorder." 4. "There is a 50% chance that your son will be a carrier only."

Answer: 4 Explanation: 4. There is a 50% chance that a carrier mother will pass the normal gene to each of her sons, who will be unaffected.

A nurse working in an infertility clinic should include which information in her discussions with the clients? 1. It is important to know the statistics surrounding couples who never learn why they are infertile. 2. Couples should understand the legal controversy concerning therapeutic insemination. 3. Couples should seek marriage counseling before undergoing fertility treatments. 4. Couples should discuss therapeutic insemination and in vitro fertilization as alternatives.

Answer: 4 Explanation: 4. This is the correct answer. This information should be presented to clients so that they are aware of all the alternatives and can make an informed decision.

A client has been diagnosed with fallopian tube obstruction and told that her best option for becoming pregnant is with in vitro fertilization. The client asks the nurse about the procedure. What is the nurse's best explanation of this procedure? 1. "In vitro fertilization (IVF) occurs over a full menstrual cycle." 2. "In IVF, a woman's ovaries are stimulated by a combination of egg and sperm donations." 3. "After ovarian stimulation, you will be inseminated with your partner's sperm." 4. "The oocytes are aspirated from the ovaries and fertilized in the laboratory."

Answer: 4 Explanation: 4. This is true. The oocytes are aspirated from the client's ovaries and fertilized in the laboratory.