infertility practice questions

22. An infertile woman has been diagnosed with endometriosis. She asks the nurse why that diagnosis has made her infertile. Which of the following explanations is appropriate for the nurse to make? 1. "Scarring surrounds the ends of your tubes preventing your eggs from being fertilized by your partner's sperm." 2. "You are producing insufficient quantities of follicle-stimulating hormone that is needed to mature an egg every month." 3. "Inside your uterus is a benign tumor that makes it impossible for the fertilized egg to implant." 4. "You have a chronic infection of the vaginal tract that makes the secretions hostile to your partner's sperm."

ANS: 1 Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The tissue may be on, for example, the tubes, ovaries, or colon. Adhesions develop from the monthly bleeding at the site of the misplaced endometrial tissue, often resulting in infertility. Endometriosis is not characterized by hormonal imbalances. Hormonal imbalances can, however, lead to infertility. A benign tumor of the muscle of the uterus is called a fibroid. It can interfere with pregnancy, but it is not related to endometriosis. Endometriosis is not caused by an infection.

21. A client in the infertility clinic is having her estrogen level tested. The nurse understands that estrogen is responsible for which effect? 1. Inhibits the production of follicle-stimulating hormone (FSH) 2. Inhibits the production of luteinizing hormone (LH) 3. Increases endometrial secretions 4. Inhibits hypertrophy of the myometrium

ANS: 1 Estrogen inhibits the production of FSH. Progesterone inhibits the production of LH. Progesterone increases endometrial secretions. Estrogen causes hypertrophy of the myometrium.

20. A nurse working in an infertility clinic should include which of the following in her discussions with the couple? 1. Adoption as an alternative to infertility treatments 2. The legal controversy surrounding artificial insemination 3. The need to seek marriage counseling before undergoing infertility treatments 4. Statistics regarding the number of couples who never learn why they are infertile.

ANS: 1 It is important for the couple to be provided with all relevant information. Adoption is a viable alternative to infertility treatments. Although there are moral/ethical issues surrounding artificial insemination, there are no legal controversies. Artificial insemination is a legal procedure. Although it is not without merit, marriage counseling is not mandatory before seeking infertility treatments. This response is not true. Although some causes of infertility may not be discovered, in the majority of cases a cause is found: 1/3 of cases related to female problems, 1/3 of cases related to male problems, and 1/3 of cases a combination of male and female problems.

27. A couple is seeking infertility counseling. The practitioner has identified the factors listed below in the woman's health history. Which of these findings may be contributing to the couple's infertility? 1. The client is 36 years old 2. The client was 13 years old when she started to menstruate 3. The client works as a dental hygienist 3 days a week 4. The client jogs 2 miles every day

ANS: 1 The eggs of an older woman (for reproductive purposes considered 35 years ) do age and fertility is reduced. Age 13 at the time of menarche is not a significant factor. Working as a dental hygienist has not been shown to affect fertility. Excessive exercise can interrupt hormonal function, but jogging 2 miles a day is a moderate exercise pattern.

18. The nurse is providing counseling to a group of sexually active single women. Most of the women have expressed a desire to have children in the future, but not within the next few years. Which of the following actions should the nurse suggest the women take to protect their fertility for the future? Select all that apply. 1. Use condoms during intercourse 2. Refrain from smoking cigarettes 3. Maintain an appropriate weight for height 4. Exercise in moderation 5. Refrain from drinking carbonated beverages

ANS: 1, 2, 3, 4 Condoms should be worn during sexual contacts to prevent becoming infected with a sexually transmitted disease, which can impact the long-term health of the woman's reproductive system. Women who smoke have a higher incidence of infertility than those who do not smoke. Women who are either overweight or underweight have increased incidence of infertility. Body mass index (BMI) is related to the amount of exercise a woman engages in. Those who exercise excessively are more likely to have a very low BMI and those who rarely exercise to be obese. Since fertility is related to body weight, it is recommended that women exercise in moderation. There is some evidence that caffeine in large quantities may affect fertility, but decaffeinated carbonated beverages have never been cited as impacting one's fertility.

36. A couple, who have been attempting to become pregnant for 5 years, is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? Select all that apply. 1. Anger at others who have babies 2. Feelings of failure because they can't make a baby 3. Sexual excitement because they want so desperately to conceive a baby 4. Sadness because of the perceived loss of being a parent 5. Guilt on the part of one partner because he or she is not able to give the other a baby

ANS: 1, 2, 4, 5 Infertility clients often express anger at others who are able to conceive. Infertility clients often express a feeling of personal failure. Sadness is another common feeling expressed by infertility clients. Guilt is commonly expressed by infertility clients. Infertility clients often express an aversion to sex because of the many restrictions/schedules/intrusions that are placed on their sexual relationship.

34. Nurses working in a midwifery office have attended a conference to learn about factors that increase a woman's risk of becoming infertile. To evaluate the nurses' learning, the conference coordinator tested the nurses' knowledge at the conclusion of the seminar. Which of the following problems should the nurses state increase a client's risk of developing infertility problems? Select all that apply. 1. Women who have menstrual cycles that are up to 30 days long 2. Women who experience pain during intercourse 3. Women who have had pelvic inflammatory disease 4. Women who have excess facial hair 5. Women who have menstrual periods that are over 5 days long.

ANS: 2, 3, 4 Dyspareunia, or pain during intercourse, may be a symptom of a sexually transmitted infection (STI) or of endometriosis. Both STIs and endometriosis can adversely affect a woman's fertility. 3. A woman who has had PID is much more likely to have blocked fallopian tubes than a woman who has never had PID. 4. Women who have facial hair (hirsutism) often have polycystic ovarian syndrome (PCO). PCO patients are usually obese and have irregular menses. Women with PCO are very often infertile. A 30-day menstrual cycle is well within normal limits. A 5-day menstrual period is well within normal limits.

42. A female client seeks care at an infertility clinic. Which of the following tests may the client undergo to determine what, if any, infertility problem she may have? Select all that apply. 1. Chorionic villus sampling 2. Endometrial biopsy 3. Hysterosalpingogram 4. Serum progesterone assay 5. Postcoital test.

ANS: 2, 3, 4, 5 Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. Hysterosalpingogram is performed after menstruation to detect whether or not the fallopian tubes are patent. Serum progesterone assay is performed about 1 week following ovulation to determine whether or not the woman's corpus luteum produces enough progesterone to sustain a pregnancy. Postcoital tests are performed about 1-2 days before ovulation to determine whether or not healthy sperm are able to survive in the cervical mucus. Chorionic villus sampling is done to assess for genetic disease in the fetus

17. Which hormone is responsible for the increase in basal body temperature? 1. Follicle-stimulating hormone 2. Gonadotropin-releasing hormone 3. Progesterone 4. Estrogen

ANS: 3 Progesterone is involved in the elevation of basal body temperature following ovulation A gonadotrophic hormone is released by the anterior pituitary. FSH is essential to the pubertal development and the growth of the ovarian follicle before the release of the egg from the follicle at ovulation. Gonadotrophin-releasing hormone stimulates the release of the gonadotropin FSH and LH from the anterior pituitary in a response to the decrease of estrogen and progesterone. Estrogen does not have a thermogenic effect on the basal body temperature.

50. A woman is trying the calendar rhythm method of natural family planning. After talking with the nurse, she understands she should subtract how many days from the end of her shortest cycle? 1. 11 2. 16 3. 18 4. 20

ANS: 3 Subtract 18 from the total number of days in the shortest cycle. This number represents the first fertile day of the cycle. Subtract 11 from the total number of days in the longest cycle. This number represents the last fertile day of the cycle.

15. A couple is seeking infertility counseling. During the history, it is noted that the man is a cancer survivor, drinks one beer every night with dinner, and takes a sauna every day after work. Which of the following is an appropriate response by the nurse? 1. It is unlikely that any of these factors is impacting his fertility. 2. Daily alcohol consumption could be causing his infertility problems. 3. Sperm may be malformed when exposed to the heat of the sauna. 4. Cancer survivors have the same fertility rates as healthy males.

ANS: 3 The high temperature of the sauna could alter the number and morphology of the sperm. Exposing the testes to the heat of the sauna can alter the normal morphology of the sperm. Alcohol consumed in excessive amounts can alter spermatogenesis, but one beer per day has not been shown to be a problem. Chemotherapy has been shown to affect the ability of males to create sperm.

19. A couple is seeking advice regarding actions that they can take to increase their potential of becoming pregnant. Which of the following recommendations should the nurse give to the couple? 1. The couple should 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 man should be on top during intercourse

ANS: 3 The woman should refrain from douching. Douching can change the normal flora and the pH in the vagina, making the environment hostile to the sperm. Use of vaginal lubricants is not recommended. Vaginal lubricants may alter the pH of the reproductive system, adversely affecting the couple's potential of becoming pregnant. Delaying intercourse until the day of ovulation is a poor recommendation. The sperm live for about 3 days. If the couple has daily intercourse beginning 5 or 6 days before ovulation and continuing until the day of ovulation, they will maximize their potential of becoming pregnant. The position of the couple during intercourse will not affect the potential fertility of the woman.

26. A 35-year-old client is being seen for her yearly gynecological examination. She states that she and her partner have been trying to become pregnant for a little over 6 months, and that a friend had recently advised her partner to take ginseng to improve the potency of his sperm. The woman states that they have decided to take their friend's advice. On which of the following information should the nurse base his or her reply? 1. Based on their history, the client and her partner have made the appropriate decision regarding their fertility 2. Ginseng can cause permanent chromosomal mutations and should be stopped immediately 3. It is unnecessary to become concerned about this woman's fertility because she has only tried to become pregnant for a few months 4. Although ginseng may be helpful, it would be prudent to encourage the woman to seek fertility counseling

ANS: 4 Because fertility drops as a woman ages, it is advisable to encourage the couple to use conventional therapies in conjunction with the complementary therapy to maximize their potential of becoming pregnant. On the web, there are sites that state that ginseng improves the quality and quantity of sperm, although there is no strong evidence to show that that is true. In addition, there is nothing in the question to suggest that the infertility problem is caused by the poor quality of her partner's sperm. There is no evidence that ginseng causes mutations; rather there is some evidence to show that it is antimutagenic. There is cause for concern for this woman since she is 35 years old and has been unable to get pregnant for over 6 months.

79. A client is being educated about the in vitro fertilization procedure. Which statement is appropriate for the nurse to make? 1. "A catheter is inserted through the cervix into the uterus and the prepared semen sample is injected into the uterus." 2. "Sperm or ovarian tissue will be frozen for future use." 3. "Fertilization will take place inside the woman's body." 4. "Fertilization and maturation of the embryos occur in the laboratory prior to embryo transfer."

ANS: 4 In vitro fertilization involves fertilization and maturation of the embryos in the laboratory prior to embryo transfer. This technique requires collection of the sperm sample and preparation of the sample in the laboratory prior to injecting into the uterus. Cryopreservation involves sperm or ovarian tissue to be frozen for future use. Fertilization does not take place inside the woman's body.

24. Infertility increases a client's risk of which of the following diseases? 1. Diabetes mellitus 2. Nystagmus 3. Cholecystitis 4. Ovarian cancer

ANS: 4 Infertility has been shown to increase a woman's risk of developing ovarian cancer. Diabetes has been shown to affect a woman's fertility, but infertility has not been shown to increase a woman's risk of developing diabetes. Infertility has not been shown to increase a woman's risk of developing nystagmus. Infertility has not been shown to increase a woman's risk of developing cholecystitis.

63. A patient is trying to learn the cervical mucus detection natural family planning method. The patient understands that which type of cervical mucus is the most fertile? 1. Scant 2. Purulent 3. Thick 4. Wet/slippery with egg white consistency

ANS: 4 So-called egg white cervical mucus is the most fertile of all cervical mucus types because it allows the sperm to swim easily into the cervix. Its consistency is similar to raw egg whites, and it can stretch an inch or two without breaking in the middle. Scant or no visible mucus is seen during the preovulatory phase. Purulent cervical discharge indicates infection. Thick cervical mucus acts as a barrier to sperm. This is seen during the postovulatory phase.

A nurse is providing counseling to a couple who is experiencing infertility issues. Which of the following statements by the nurse is appropriate? a. "even though you cant have children biologically, you can always adopt a child" b. "you need to take a break from these attempts to conceive" c. "you might want to join our support group for couples who are experiencing similar problems" d. "why didnt you get immunizations when you were younger?"

ANS: C An invitation to join a support group will promote social, emotional, and spiritual growth. Many positive results from peer support can occur. A's response does not show sensitivity to couples feelings. B's response ignores the helplessness and depression the couple may be feeling. There is no indication that the couple's infertility is due to lack of immunizations.