Familes/Children Exam 2: Human Reproduction

A 39 year old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which client statement indicates effective teaching? 1. My fallopian tubes will be tied off thru a small abdominal incision 2. reversal of tubal ligation is easily done with a pregnancy success rate of 80% 3. after this procedure I must abstain from sex for at least 3 weeks 4. both of my ovaries will be removed during the tubal ligation

1

Advantages & Disadvantages of BBT:

Advantages: Inexpensive, convenient, and no adverse effects Disadvantages: - Reliability can be influenced by many variables that can cause inaccurate interpretation of temperature changes (stress, fatigue, illness, alcohol, warmth of sleeping environment). - Does not protect against STIs.

Surgical Methods: Tubal Ligation (Bilateral Tubal Ligation-BTL) -

- surgical procedure consisting of severance and/or burning or blocking the fallopian tubes to prevent fertilization. If using federal funding for procedure, the client must be at least 21 years of age, provide informed consent, and wait about 30 days after providing consent to have procedure. Procedure: The cutting, burning, or blocking of the fallopian tubes with bands or clips (highly reversible) to prevent the ovum from being fertilized by the sperm.

The nurse is caring for a patient who is scheduled to undergo a hysterosalpingogram. What possible abnormalities can be detected through the procedure? 1 Presence of infection 2 Blockage in the fallopian tubes 3 Decrease in ovarian reserve 4 Abnormal endometrial tissue

2

A 23-year-old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to do which of the following? A) Check the cervical mucus to see if it is thick and sparse. B) Take her temperature at the same time every morning. C) Document ovulation when the temperature decreases at least 1°F. D) Avoid coitus for 10 days after a slight rise in temperature.

B

Which of the following instructions should be included in the nurse's teaching regarding oral contraceptives? a. Weight gain should be reported to the physician. b. An alternate method of birth control is needed when taking antibiotics. c. If the client misses one or more pills, two pills should be taken per day for 1 week. d. Changes in the menstrual flow should be reported to the physician.

B

Disadvantages

Does not protect against STIs. Can increase the risk of thromboembolism, stroke, heart attack, hypertension, gallbladder disease, and liver tumor. Exacerbates conditions affected by fluid retention (migraine, epilepsy, asthma, kidney or heart disease). Adverse effects include headache, nausea, breast tenderness, and breakthrough bleeding. (Estrogen can cause nausea, breast tenderness, fluid retention. Progestin can cause increased appetite, fatigue, depression, breast tenderness, oily skin and scalp, and hirsutism.)

A nurse is reinforcing teaching about contraceptive methods with a client. Which of the following should the nurse recognize as a contradiction for diaphragm use? -The client is 42 years old. -The client has a 3-month-old infant. -The client smokes cigarettes. -The client has pelvic relaxation

The client has pelvic relaxation. (Pelvic relaxation and large cystocele are contraindications for diaphragm use.)

A woman is taking oral contraceptives. The nurse teaches the client to report which complication? 1. breakthrough bleeding 2. severe calf pain 3. mild headache 4. weight gain of 3 lb

2

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following? A) Anemia. B) Hypertension. C) Dysmenorrhea. D) Acne vulgaris.

B

A female client and her husband are exploring operative types of sterilization. The couple is now discussing the benefits of, and risks associated with, having a vasectomy. Which misconception about vasectomies needs to be clarified with the couple before their decision is made? a. Once the vasectomy procedure is complete, sterilization is immediately achieved. b. A couple is advised to use another form of birth control for about 4 to 6 weeks after the procedure. c. A vasectomy is a surgical procedure that severs the vas deferens in both sides of the scrotum.d. The man needs to be rechecked at 6 and 12 months to ensure that fertility has not been restored by recanalization.

A

A nurse is reviewing a basal body temperature chart with a couple. Which change would indicate probable ovulation? a) A decrease in temperature followed by an increase for several days b) An increase in temperature followed by a decrease for several days c) A decrease in temperature that remains until menses begins d) A steadily increasing temperature over seven days

A

Barrier Method: Diaphragm

A dome-shaped cup with a flexible rim made of silicone that fits snugly over the cervix. The effectiveness is increased with the use of a spermicidal cream or gel placed into the dome and around the rim.

A male patient is considering a vasectomy. Which information should the nurse instruct the patient about this procedure? (Select all that apply.) A)Sexual intercourse can resume in a week. B)The procedure can be done as an outpatient. C)An opioid analgesic will be prescribed for pain control. D)Use a birth control method until a negative sperm reports occur. E)Spermatozoa present in the vas deferens will be viable for 2 weeks.

A, B, D

Advantages & Disadvantages

Advantages: Permanent, immediate contraception. This method can be done within 24 to 48 hr after childbirth. Sexual function is unaffected. Disadvantages: A surgical procedure carrying risks related to anesthesia, complications, infection, hemorrhage, trauma Considered irreversible if a client desires conception Does not protect against STIs

Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning? A) Douching with an acidic solution after intercourse is recommended. B) Diaphragms should not be used if the client develops acute cervicitis. C) The diaphragm should be washed in a weak solution of bleach and water. D) The diaphragm should be left in place for 2 hours after intercourse.

B

Client Education

Take temperature immediately after waking up and before getting out of bed. If working at night, take temperature after awakening from the longest sleep cycle. Use a thermometer that records temperature to the tenths. Record the temperatures on a specialized graph. During ovulation as the progesterone rises some clients may see a slight elevation in their basal body temperature. ​​​​​​​Fertility extends through 3 consecutive days of temperature elevations. Use this method with the calendar method to increase effectiveness.

Basal body temperature (BBT)

BBT is the temperature of the body at rest. During ovulation as the progesterone raises some clients may see a slight elevation in their basal body temperature. Identifying the time of ovulation is a symptom-based method that can be used to facilitate or avoid conception.

Client Education

Be properly fitted with a diaphragm by a provider. Replace every 2 years and refit for a 20% weight fluctuation, after abdominal or pelvic surgery, and after every pregnancy. The diaphragm requires proper insertion and removal. Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or cream that is applied to the cervical side of the dome and around the rim. The diaphragm can be inserted up to 6 hr before intercourse and must stay in place 6 hr after intercourse but for no more than 24 hr. Spermicide must be reapplied with each act of coitus. Empty the bladder prior to insertion of the diaphragm, to decrease pressure on the urethra. The diaphragm should be washed with mild soap and warm water after each use.

A adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by; A. Return preovulatory basal body temperature B. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle C. 3 full days of elevated basal body temperature and clear, thin cervical mucus D. Breast tenderness and mittelschmerz

C

A married woman presents to the infertility clinic. She reports an inability to get pregnant again. She has no children, and a history of two ectopic pregnancies. The nurse can anticipate which test or workup to be ordered for this client? a. Endometrial biopsy. b. Huhner test. c. Hysterosalpingography. d. Basal body temperature recording.

C

Discussing diaphragm use with a client. Which statement by the client indicates an understanding of the teaching? A. "I should clean my diaphragm with alcohol each time I use it." B. "I should leave the diaphragm in place 4 hours after intercourse." C. "I should replace my diaphragm every 2 years." D. "I should use a vaginal lubricant to insert my diaphragm."

C

A nurse is teaching a patient how to use a diaphragm. Which of the following instructions should the nurse include? A."You should replace the diaphragm every year.". B. "You should insert the diaphragm after intercourse.". C. "You should wash the diaphragm with hot water and strong soap.". D. "You should empty your bladder before inserting the diaphragm.".

D

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching? A) "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case." B) "If I get pregnant, I will have to be refitted for another diaphragm after the delivery." C) "Before inserting the diaphragm I should coat the rim with contraceptive jelly." D) "If I gain or lose 20 pounds, I can still use the same diaphragm."

D

Advantages: Method is permanent. Procedure is short, safe, and simple. Sexual function is not impaired.

Disadvantages: Surgery is required. Reversal is possible but not always successful. This method does not protect against STIs. Accumulation of sperm can cause granulomas.

Advantages

Highly effective if taken correctly and consistently, preferably at the same time each day. Hormonal contraception containing low-dose estrogen (less than 35 mcg) has other therapeutic effects, including decreased menstrual blood loss, decreased iron deficiency anemia, regulation of menorrhagia and irregular cycles, and reduced incidence of dysmenorrhea and premenstrual findings. Offers protection against endometrial, ovarian, and colon cancer, reduces the incidence of benign breast disease, improves acne, and protects against the development of functional ovarian cysts.

Outpatient radiological procedure in which dye is used to assess the patency of the fallopian tubes. Assess for history of allergies to iodine and seafood prior to beginning the procedure. Contrast media (iodine) may not always be a contraindication in clients who have a shellfish allergy. Further assessment may be needed.

Hysterosalpingography

Risks/Possible Complications/Contraindications

Not recommended for clients who have a history of toxic shock syndrome (TSS), cystocele, uterine prolapse, or frequent, recurrent urinary tract infections. Increased risk of acquiring TSS, which is caused by a bacterial infection. Clinical findings include high fever, a faint feeling, drop in blood pressure, watery diarrhea, headache, macular rash, and muscle aches. Proper hand hygiene aids in prevention of TSS, as well as removing the diaphragm promptly 6 to 8 hr following coitus. Risk of allergic reaction and UTIs.

Hormonal Methods- the pill

estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation

Vasectomy-

surgical procedure consisting of ligation and severance of the vas deferens, which prevents sperm from traveling Procedure:The cutting of the vas deferens as a form of permanent sterilization.