Maternity Nursing Chapter 5

Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause. a. Ovarian d. Vaginal/cervical b. Tubal/peritoneal e. Other factors c. Uterine 35. Endometrial or myometrial tumors 36. Anorexia 37. Isoimmunization 38. Thyroid dysfunction or obesity 39. Endometriosis

35. ANS: C PTS: 1 DIF: Cognitive Level: Comprehension REF: 110 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance NOT: Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Ashermans syndrome. Vaginal- cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions. 36. ANS: A PTS: 1 DIF: Cognitive Level: Comprehension REF: 110 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance NOT: Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Ashermans syndrome. Vaginal- cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions. 37. ANS: D PTS: 1 DIF: Cognitive Level: Comprehension REF: 110 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance NOT: Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Ashermans syndrome. Vaginal- cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions. 38. ANS: E PTS: 1 DIF: Cognitive Level: Comprehension REF: 110 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance NOT: Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Ashermans syndrome. Vaginal- cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions. 39. ANS: B PTS: 1 DIF: Cognitive Level: Comprehension REF: 110 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance NOT: Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Ashermans syndrome. Vaginal- cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.

40. Practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the womans cycles vary in length from 24 to 30 days, what would her fertile period be? ________ to _________

ANS: Day 6 to day 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

6. In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurses most appropriate response is: a. IVF-ET is a type of assisted reproductive therapy that involves collecting eggs from your wifes ovaries, fertilizing them in the laboratory with your sperm, and transferring the embryo to her uterus. b. A donor embryo will be transferred into your wifes uterus. c. Donor sperm will be used to inseminate your wife. d. Dont worry about the technical stuff; thats what we are here for.

ANS: A A womans eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred. The statement, A donor embryo will be transferred into your wifes uterus describes therapeutic donor insemination. Donor sperm will be used to inseminate your wife describes the procedure for a donor embryo. Dont worry about the technical stuff; thats what we are here for discredits the clients need for teaching and is an inappropriate response.

31. Postcoital contraception with Ovral: a. Requires that the first dose be taken within 72 hours of unprotected intercourse. b. Requires that the woman take second and third doses at 24 and 36 hours after the first dose. c. Must be taken in conjunction with an IUD insertion. d. Is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception is most effective when used within 72 hours of intercourse; however, it may be used with lessened effectiveness 120 hours later. Insertion of the copper IUD within 5 days of intercourse may also be used and is up to 99% effective. The most common side effect of postcoital contraception is nausea.

11. A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse: a. Obtain a history of menstrual cycle lengths for the past 6 to 12 months. b. Determine the clients weight gain and loss pattern for the previous year. c. Examine skin pigmentation and hair texture for hormonal changes. d.Explore the clients previous experiences with conception control.

ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but it is not the most important aspect to assess for discussion of the calendar method.

33. A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurses most appropriate response is: a. This is a legitimate concern. Would you like to discuss this further before your treatment begins? b. No one has ever had more than triplets with Clomid. c. Ovulation will be monitored with ultrasound so that this will not happen. d. Ten percent is a very low risk, so you dont need to worry too much.

ANS: A The incidence of multiple pregnancies with the use of these medications is significantly increased. The patients concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had more than triplets is inaccurate and negates the patients concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur. The percentage quoted in this statement is inaccurate. The comment dont worry discredits the patients concern.

20. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is: a. Dilation and evacuation (D&E). b. Instillation of hypertonic saline into the uterine cavity. c. Intravenous administration of Pitocin. d. V acuum aspiration.

ANS: A The most common technique for medical termination of a pregnancy in the second trimester is D&E. It is usually performed between 13 and 16 weeks. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. Intravenous administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester.

25. Which contraceptive method has a failure rate of less than 25%? a. Standard days b. Periodic abstinence c. Postovulation d. Coitus interruptus

ANS: A The standard days variation on the calendar method has a failure rate of 12%. The periodic abstinence method has a failure rate of 25% or greater. The postovulation method has a failure rate of 25% or greater. The coitus interruptus method has a failure rate of 27% or greater.

7. Nurses should be aware that infertility: a. Is perceived differently by women and men. b. Has a relatively stable prevalence among the overall population and throughout a women's potential reproductive years. c. Is more likely the result of a physical flaw in the woman than in her male partner. d. Is the same thing as sterility.

ANS: A Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a womans age, especially after age 40. Of cases with an identifiable cause, about 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility, or subfertility, is a state of requiring a prolonged time to conceive.

18. A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should she and her partner avoid? a. Cervical cap b. Condom c. Vaginal film d. Vaginal sheath

ANS: A Women with a history of TSS should not use a cervical cap. Condoms, vaginal films, and vaginal sheaths are not contraindicated for a woman with a history of TSS.

34. You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out (Select all that apply)? a. It is highly unlikely that you will become pregnant after the procedure. b. This is an effective form of 100% permanent sterilization. You wont be able to get pregnant. c. Sterilization offers some form of protection against sexually transmitted infections (STIs). d. Sterilization offers no protection against STIs. e. Your menstrual cycle will greatly increase after your sterilization.

ANS: A, D A woman is unlikely to become pregnant after tubal ligation, although it is not 100% effective. Sterilization offers no protection against STIs. The menstrual cycle typically remains the same after a tubal ligation.

26. Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. They all offer about the same protection.

ANS: B Barrier methods such as condoms best protect against STIs and HIV. Periodic abstinence and hormonal methods (the pill) offer no protection against STIs or HIV.

15. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurses most appropriate response would be: a. This is a highly effective method, but it has some side effects. b. Your current medications will reduce the effectiveness of the pill. c. The pill will reduce the effectiveness of your seizure medication. d. This is a good choice for a woman of your age and personal history.

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants. The statement Your current medications will reduce the effectiveness of the pill is true, but it is not the most appropriate response. The anticonvulsant will reduce the effectiveness of the pill, not the other way around. The statement This is a good choice for a woman of your age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

19. An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurses most appropriate response is: a. The IUD does not interfere with sex. b. The risk of pelvic inflammatory disease (PID) will be higher for you. c. The IUD will protect you from sexually transmitted infections (STIs). d. Pregnancy rates are high with IUDs.

ANS: B Disadvantages of IUDs include an increased risk of PID in the first 20 days after insertion and the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against STIs or human immunodeficiency virus. Because this woman has multiple sex partners, she is at higher risk of developing a STI. The IUD does not protect against infection, as does a barrier method. Although the statement The IUD does not interfere with sex may be correct, it is not the most appropriate response. The IUD offers no protection from STIs. The typical failure rate of the IUD in the first year of use is 0.8%.

1. Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle? a. Hysterosalpingogram b. Endometrial biopsy c. Laparoscopy d. Follicle-stimulating hormone (FSH) level

ANS: B Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy usually is scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

3. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurses most appropriate reply is: a. Theyre not very effective, and its very likely youll get pregnant. b. They can be effective for many couples, but they require motivation. c. These methods have a few advantages and several health risks. d. You would be much safer going on the pill and not having to worry.

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and adherence to coitus intervals. They are effective if used correctly by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 25% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the clients part.

8. With regard to the assessment of female, male, and couple infertility, nurses should be aware that: a. The couples religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis. b. The investigation takes 3 to 4 months and a significant financial investment. c. The woman is assessed first; if she is not the problem, the male partner is analyzed. d. Semen analysis is for men; the postcoital test is for women.

ANS: B Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an impact on diagnosis and assessment. Both partners are assessed systematically and simultaneously, as individuals and as a couple. Semen analysis is for men, but the postcoital test is for the couple.

5. A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the client in which herbal preparations to avoid while trying to conceive? a. You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant. b. You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive. c. You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile. d. Herbs have no bearing on fertility.

ANS: B Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, golden seal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E all promote fertility. Vitamin E, calcium, and magnesium may promote fertility and conception. All supplements and herbs should be purchased from trusted sources.

14. A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurses most appropriate response is: a. The lubricant prevents vaginal irritation. b.Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; it has also been linked to an increase in the transmission of human immunodeficiency virus and can cause genital lesions. c. The additional lubrication improves sex. d. Nonoxynol-9 improves penile sensitivity.

ANS: B The statement Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; it has also been linked to an increase in the transmission of human immunodeficiency virus and can cause genital lesions is true. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.

28. With regard to the use of intrauterine devices (IUDs), nurses should be aware that: a. Return to fertility can take several weeks after the device is removed. b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c. IUDs offer the same protection against sexually transmitted infections (STIs) as the diaphragm. d. Consent forms are not needed for IUD insertion.

ANS: B The woman has up to 8 days to insert the IUD after unprotected sex. Return to fertility is immediate after removal of the IUD. IUDs offer no protection for STIs. A consent form is required for insertion, as is a negative pregnancy test.

30. Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the womans social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the womans level of knowledge about contraception and commitment to any particular method. c. Assess the womans willingness to touch her genitals and cervical mucus. d. Evaluate the womans contraceptive life plan.

ANS: B This is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from sexually transmitted infections, and a partners willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

16. Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who: a. Want menstrual regularity and predictability. b. Have a history of thrombotic problems or breast cancer. c. Have difficulty remembering to take oral contraceptives daily. d. Are homeless or mobile and rarely receive health care.

ANS: C Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

24. While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning: a. Is the same as coitus interruptus, or pulling out. b. Uses the calendar method to align the womans cycle with the natural phases of the moon. c. Is the only contraceptive practice acceptable to the Roman Catholic church. d. Relies on barrier methods during fertility phases.

ANS: C Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers. Natural family planning is the only contraceptive practice acceptable to the Roman Catholic church. Pulling out is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method.

17. A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurses most appropriate response is: a. No spermicide is used with the cervical cap, so its less messy. b. The diaphragm can be left in place longer after intercourse. c. Repeated intercourse with the diaphragm is more convenient. d. The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later.

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is required for repeated acts of intercourse. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

3. A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed? a. Testicular biopsy b. Antisperm antibodies c. Follicle-stimulating hormone (FSH) level d. Examination for testicular infection

ANS: C The woman has irregular menstrual cycles. The scenario does not indicate that she has had any testing related to this irregularity. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary- ovarian axis when menstrual cycles are absent or irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles. A testicular biopsy would be indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Antisperm antibodies are produced by a man against his own sperm. This is unlikely to be the case here because the man has already produced children. Examination for testicular infection would be done before semen analysis. Infection would affect spermatogenesis.

21. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by: a. Limiting sexual contact for one cycle after starting the pill. b. Using condoms and foam instead of the pill for as long as she takes an antibiotic. c. Taking one pill at the same time every day. d. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle.

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or abortion, another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormone levels in oral contraceptive users. If the client misses two pills during week 1, she should take two pills a day for 2 days, finish the package, and use a backup method the next 7 consecutive days.

22. A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her fertile time. She asks the nurse about emergency contraception. The nurse tells her that: a. It is too late; she needed to begin treatment within 24 hours after intercourse. b. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy. c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting. d. The most effective approach is to use a progestin-only preparation.

ANS: C To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose. Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy. Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy. Oral emergency contraceptive regimens may include progestin-only and estrogen- progestin pills. Women with contraindications to estrogen use should use progestin-only pills.

4. A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurses most appropriate response is: a. Tell your friends and family so they can help you. b. Talk only to other friends who are infertile because only they can help. c. Get involved with a support group. Ill give you some names. d. Start adoption proceedings immediately because it is very difficult to obtain an infant.

ANS: C Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others experiences. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couples relationships with family and friends. Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs, but depending on where the other couple is in their own recovery process, this may or may not help them. The statement about adoption proceedings is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

10. Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment? a. Risks of multiple gestation b. Whether or how to disclose the facts of conception to offspring c. Freezing embryos for later use d. Financial ability to cover the cost of treatment

ANS: D Although the method of payment is important, obtaining this information is not the responsibility of the nurse. Many states have mandated some form of insurance to assist couples with coverage for infertility. Risk of multiple gestation is a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or a surrogate mother. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time.

23. Which statement is true about the term contraceptive failure rate? a. It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b. It refers to the minimum level that must be achieved to receive a government license. c. It increases over time as couples become more careless. d. It varies from couple to couple, depending on the method and the users.

ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

29. Which of the following statements is the most complete and accurate description of medical abortions? a. They are performed only for maternal health. b. They can be achieved through surgical procedures or with drugs. c. They are mostly performed in the second trimester. d. They can be either elective or therapeutic.

ANS: D Medical abortions are performed through the use of medications (rather than surgical procedures). They are mostly done in the first trimester, and they can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health).

9. In their role of implementing a plan of care for infertile couples, nurses should: a. Be comfortable with their sexuality and nonjudgmental about others to counsel their clients effectively. b. Know about such nonmedical remedies as diet, exercise, and stress management. c. Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid. d. Do all of the above plus be knowledgeable about potential drug and surgical remedies.

ANS: D Nurses should be open to and ready to help with a variety of medical and nonmedical approaches.

12. A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone up. The nurses most appropriate response is: a. This probably means that youre pregnant. b. Dont worry; its probably nothing. c. Have you been sick this month? d. You probably didnt ovulate during this cycle.

ANS: D The absence of a temperature decrease most likely is the result of lack of ovulation. Pregnancy cannot occur without ovulation (which is being measured using the BBT method). A comment such as Dont worry; its probably nothing discredits the clients concerns. Illness would most likely cause an increase in BBT.

27. With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), nurses should be aware that: a. COCs can cause toxic shock syndrome if the prescription is wrong. b. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week. c. COCs increase the risk of endometrial and ovarian cancer. d. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

ANS: D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. Toxic shock syndrome can occur in some diaphragm users, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.

32. Informed consent concerning contraceptive use is important because some of the methods: a. Are invasive procedures that require hospitalization b. Require a surgical procedure to insert c. May not be reliable d. Have potentially dangerous side effects

ANS: D To make an informed decision about the use of contraceptives, it is important for couples to be aware of potential side effects. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this should be included in the teaching.

2. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurses most appropriate response is: a. Your sperm count seems to be okay in the first semen analysis. b. Only marijuana cigarettes affect sperm count. c. Smoking can give you lung cancer, even though it has no effect on sperm. d. Smoking can reduce the quality of your sperm.

ANS: D Use of tobacco, alcohol, and marijuana may affect sperm counts. Your sperm count seems to be okay in the first semen analysis is inaccurate. Sperm counts vary from day to day and depend on emotional and physical status and sexual activity. A single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility.