Chapter 31: Family Planning 4 & 6

17. 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.

A

20. A couple are asking the nurse about in vitro fertilization. What explanation by the nurse is best? a."IVF places the product of conception from your sperm and her egg into the uterus." b."A donor embryo will be transferred into your wife's uterus." c."Donor sperm will be used to inseminate your wife." d."Don't worry about the technical stuff; that's what we are here for."

A

20. In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their pre-procedural interview. The husband asks the nurse to explain what the procedure entails. The nurses most appropriate response is a.IVF is a type of assisted reproductive therapy that involves collecting eggs from your wifes ovaries, fertilizing them in the lab 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.

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.

9. 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

A Emergency contraception is most effective when used within 72 hours of intercourse but may be used with lessened effectiveness up to 120 hours later.

1. The conscious decision on when to conceive or avoid pregnancy throughout the reproductive years is called a.Family planning b.Birth control c.Contraception d.Assisted reproductive therapy

A Family planning is the process of deciding when and if to have children.

1. The ____________ is one method used to evaluate the adequacy of coital technique, cervical mucous, sperm quality and penetration.

ANS: postcoital test This test is performed within several hours after ejaculation of semen into the vagina and is used to study a number of factors affecting fertility.

17. The most appropriate statement for introducing the topic of family planning in the postpartum setting is: a."What are your plans for future pregnancies?" b."Do you plan on being sexually active in the future?" c."Let's talk about birth control, because breastfeeding is not 100% effective for preventing pregnancy." d."Here are some pamphlets on available methods of birth control. I'll come back later and discuss them with you."

ANS: A Discussing future pregnancy plans opens the conversation to ways of preventing pregnancy from occurring before the woman is ready. "Do you plan on being sexually active in the future?" will only provide a yes or no answer and not allow for conversation. The family needs to be ready to talk about birth control; the effect of breastfeeding on birth control is applicable only to the woman. Pamphlets are not always the best form of teaching; the woman is usually too tired and overwhelmed to read. PTS: 1 DIF: Cognitive Level: Application REF: 698

23. A client is using Depo-Provera as her method of birth control. Which finding warrants immediate intervention? a.Mid-cycle bleeding b.Nausea c.Temperature of 100° F d.Irregular periods

ANS: A When using Depo-Provera, the major side effect is irregular bleeding. The presence of mid-cycle bleeding warrants further investigation at this time so it is the priority assessment. PTS: 1 DIF: Cognitive Level: Application REF: 688

22. A woman has been prescribed metformin at the infertility clinic. She says "Why am I on this? I am not a diabetic; my sister takes it for her diabetes!" What response by the nurse is best? a."It is used to promote ovulation in polycystic ovary disease." b."It will prevent your body from forming antibodies to sperm." c."It helps prepare the uterine lining for eventual implantation." d."I don't know but I will find out and let you know right away."

ANS: A Metformin is used as an adjunctive therapy to promote ovulation in the woman with polycystic ovary disease. It does not prevent antibody formation or prepare the uterine lining. The nurse should know this information but if he or she does not know, finding out and telling the woman as soon as possible would be the correct response.

1. You (the nurse) are reviewing the educational packet provided to a patient 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 diseases. d.Sterilization offers no protection against sexually transmitted diseases. e.Your menstrual cycle will greatly increase after your sterilization.

ANS: A, D Feedback Correct A woman is unlikely to become pregnant after tubal ligation. Sterilization offers no protection against STDs.

24. A client has had a prior history of endometriosis and comes to the clinic asking about which method of birth control might be helpful to alleviate her symptoms. Which birth control method should the client use? a.Withdrawal method b.Oral contraceptives c.Depo-Provera d.Intrauterine device (IUD)

ANS: B A client who has a history of endometriosis may gain additional benefit from using an oral contraceptive as her birth control method because hormone levels will be more uniformly regulated with this type of treatment. The withdrawal method and Depo-Provera will not provide any additional benefit relative to a history of endometriosis. An IUD may cause further irritation to the endometrial lining so it would not be a prudent choice. PTS: 1 DIF: Cognitive Level: Application REF: 689

14. A woman who has a successful career and a busy lifestyle will most likely look for which type of contraceptive? a.Requires extensive education to use b.Is the easiest and most convenient to use c.Costs the least d.Is permanent

ANS: B A woman who has a busy life will probably have less time to devote to contraceptive use, so she needs something that is easy and convenient. Extra time for education would not be acceptable for this woman. Cost would probably not be a problem with this woman. There is no indication that a woman who has a successful career and a busy lifestyle wants it to be permanent, just easy. PTS: 1 DIF: Cognitive Level: Understanding REF: 698

20. A client presents to the Women's Health Clinic for continuation of her contraceptive method. She has been using Depo-Provera (medroxyprogesterone acetate) for 24 months. In preparation for instituting a plan of care, the nurse would consider which option as a priority? a.Schedule the client for follow-up baseline diagnostic testing to confirm that the client is not pregnant. b.Obtain information for an alternate contraception method. c.Ask the client for additional information related to her menstrual cycle. d.Inspect the skin for site selection of contraceptive method.

ANS: B According to WHO (World Health Organization) guidelines, women should not be on Depo-Provera for more than 2 years because of bone density loss. Therefore, the nurse should include assessments for other types of contraception methods for the client. Although it may prove to be important to rule out possible pregnancy, based on the provided information, discontinuation of this method is the priority intervention. Depo-Provera can cause menstrual irregularities, but this is not the priority intervention. The nurse can follow up on this issue later. Because the current method of contraception should no longer be used, this option is not necessary. PTS: 1 DIF: Cognitive Level: Analysis REF: 688

7. When instructing a client in the use of spermicidal foam or gel, it is important to include the information that: a.effectiveness is about 85%. b.douching should be avoided for at least 6 hours. c.it should be inserted 1 to 2 hours before intercourse. d.one application is effective for several hours.

ANS: B Douching within 6 hours of intercourse would remove the spermicide and increase the risk of pregnancy. Effectiveness is only 29% when used alone. The spermicidal foam or gel should be inserted 15 minutes before intercourse. One application is effective for about 1 hour. PTS: 1 DIF: Cognitive Level: Application REF: 695

8. Which symptom in a client using oral contraceptives should be reported to the physician immediately? a.5-lb weight gain b.Leg pain and edema c.Decrease in menstrual flow d.Increased pigmentation of the face

ANS: B Oral contraceptives increase clotting factors, which place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain can be expected. A decrease in menstrual flow is an expected finding. Increased pigmentation of the face is a common finding. PTS: 1 DIF: Cognitive Level: Application REF: 689

22. Which of the following is a potential disadvantage for a client who wishes to use an intrauterine device (IUD) as a method of birth control? a.Insertion of the device prior to coitus resulting in decreased spontaneity b.Ectopic pregnancy c.Protection against STDs d.Decrease in dysmenorrhea

ANS: B The insertion of an IUD is done in a health care provider's office. An ectopic pregnancy can occur as a possible complication of the IUD. An IUD does not offer protection against STDs. A decrease in dysmenorrhea would be an advantage of using an IUD. PTS: 1 DIF: Cognitive Level: Application REF: 688, 690

19. You are teaching a group of adolescents about myths and facts related to contraception. Which statement indicates that additional teaching is needed for this group with regard to contraception? a.Adolescents are more likely to become pregnant even if they use available contraception methods correctly. b.The withdrawal technique provides a higher likelihood that a teen will not get pregnant. c.Pregnancy can occur in the presence or absence of orgasm. d.Pregnancy can occur even if a teen is menstruating at the time of coitus.

ANS: B The withdrawal technique does not decrease the likelihood of becoming pregnant for a teen because it is unreliable in application and, even without penetration, ejaculation can result in pregnancy. It is true that adolescents are more likely to become pregnant even if they correctly use available contraception methods, based on current clinical evidence, because they are more likely to have contraceptive failure in the context of decreased knowledge. It is also true that pregnancy can occur in the presence or absence of orgasm, and even if a teen is menstruating at the time of coitus. PTS: 1 DIF: Cognitive Level: Application REF: 685

2. The nurse teaches women to recognize signs of complications when using oral contraceptives using the acronym ACHES. What does this acronym stand for? (Select all that apply.) a.Aching all over b.Chest pain, dyspnea, hemoptysis, cough c.Severe headache, weakness or numbness of extremities, and hypertension d.Eye problems e.Several swollen areas all over the body

ANS: B, C, D, E ACHES stands for Abdominal pain (severe,) Chest pain, dyspnea, hemoptysis, cough, severe Headache, severe weakness or numbness of extremities, hypertension, Eye problems, and severe pain or Swelling, heat, or redness of calf or thigh. It does not include aching all over.

15. The method of contraception that is considered the safest for women is a(n): a.IUD. b.diaphragm. c.male condom. d.oral contraceptive.

ANS: C A male condom does not have any side effects or risk factors for the woman. Oral contraception, an IUD, and the diaphragm all have significant side effects or risk factors for the woman. PTS: 1 DIF: Cognitive Level: Understanding REF: 694

1. Which contraceptive method provides protection against sexually transmitted diseases? a.Oral contraceptives b.Tubal ligation c.Male or female condoms d.Intrauterine device (IUD)

ANS: C Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease. Only the barrier methods provide some protection from sexually transmitted diseases. A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted diseases. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted diseases. PTS: 1 DIF: Cognitive Level: Understanding REF: 693

25. You are assessing a client in the clinic setting who has been taking oral contraceptives for several years, without side effects. Vital signs are stable and the client denies any pain or tenderness. On examination, you note a small erythematous area of approximately 2 cm on her right lower leg. She denies any traumatic injury and says this is a recent onset of a few days. Based on this information you would: a.instruct the client to use warm compresses for several days and keep the leg elevated as much as possible. b.have the client wear flats rather than heels to modify her gait and help alleviate this issue. c.refer the client to the health care provider for additional diagnostic work up. d.have the client take an over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) and return to the clinic if the problem persists.

ANS: C Because the client has a history of taking oral contraceptives, the nurse must assess and evaluate findings relative to ACHES (warning signs of oral contraceptives). Thus, the client should be worked up for the possibility of a superficial or deep vein thrombosis (DVT). Warm compresses and elevation of the leg, wearing flats, and taking an OTC NSAID may lead to further problems if there is an underlying clot that is not addressed promptly. PTS: 1 DIF: Cognitive Level: Application REF: 692

12. The client who has had an intrauterine device (IUD) inserted should be instructed to: a.use a vinegar douche weekly for 4 weeks. b.have the IUD replaced every 2 to 4 years. c.check the placement of the string once a week for 4 weeks. d.use another method of contraception for 2 weeks after insertion.

ANS: C Checking the placement of the string is necessary to determine whether the IUD is still correctly positioned. If the string is shorter or longer than when checked previously, she should contact her physician. A vinegar douche weekly for 4 weeks is not required. An IUD can be left in place for up to 10 years. A second method of contraception is not required after insertion of the IUD; it is effective immediately. PTS: 1 DIF: Cognitive Level: Application REF: 688

5. Informed consent concerning contraceptive use is important because some of the methods: a.may not be reliable. b.require a surgical procedure to insert. c.have potentially dangerous side effects. d.are invasive procedures that require hospitalization.

ANS: C It is important for couples to be aware of potential side effects so they can make an informed decision about the use of contraceptives. Some contraceptives are not reliable but the side effects are the reason for the informed consent. A written consent is required if it involves a surgical procedure. Some contraceptive procedures are invasive but do not require hospitalization. PTS: 1 DIF: Cognitive Level: Understanding REF: 684

16. A client is 27 years old and delivered her first baby yesterday. She and her husband do not want to have another baby for at least 3 to 4 years. The best method of birth control to meet their needs is: a.withdrawal. b.fertility awareness method. c.combination of condoms and foam. d.vasectomy with a reversal in 3 years.

ANS: C Of the methods listed, condoms and foam would be the best for this couple. Withdrawal is the least effective form of birth control. Fertility awareness is not that effective and an unwanted pregnancy could result. They want another child so a vasectomy with a reversal would not be an appropriate option. PTS: 1 DIF: Cognitive Level: Application REF: 680, 681

10. When using the basal body temperature method of family planning, the woman should know that: a.she will remain fertile for 5 days after ovulation. b.she should take her temperature each night before going to bed. c.her temperature will increase about 0.4° to 0.8° F after ovulation. d.her temperature is normally lower during the second half of her cycle.

ANS: C The basal body temperature will increase about 0.4° to 0.8° F when ovulation occurs. The woman is fertile for up to 18 days. She should take her temperature on rising in the morning. A woman's temperature is usually higher in the second half of her cycle. PTS: 1 DIF: Cognitive Level: Understanding REF: 696

6. Which contraceptive method should be contraindicated in a client with a history of toxic shock syndrome? a.Condom b.Spermicide c.Cervical cap d.Oral contraceptives

ANS: C The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. A condom is not contraindicated with a history of toxic shock syndrome. Spermicide is not contraindicated with a history of toxic shock syndrome. Oral contraceptives are not contraindicated with a history of toxic shock syndrome. PTS: 1 DIF: Cognitive Level: Understanding REF: 694

21. Which of the statements is correct regarding use of contraception and the occurrence of sexually transmitted diseases (STDs)? a.As long as the oral contraception method is used correctly, there is no transmission of STDs during sexual activity. b.Oral contraceptives provide the greatest protection against getting STDs. c.Barrier methods, if used correctly, are more likely to protect individuals from STDs as compared with other contraceptive methods. d.It is less likely to see transmission of STDs if clients engage in oral sex as opposed to vaginal penetration.

ANS: C The correct use of barrier methods helps protect against the transmission of STDs compared with other methods of contraception. The use of oral contraceptives has no effect on the transmission of STDs. The effectiveness of oral contraceptives is increased related to the prevention of pregnancy compared with other methods with the exception of abstinence. The method of sexual activity does not affect the transmission of STDs. PTS: 1 DIF: Cognitive Level: Application REF: 693

11. The major difference between the diaphragm and the cervical cap is that the diaphragm: a.is more effective. b.requires spermicide. c.applies pressure on the urethra. d.has no contribution to toxic shock syndrome.

ANS: C The diaphragm is made to fit snugly in the vaginal area and contains a hard rim that may put pressure on the urethra. The cervical cap is smaller and fits around the cervix. The cervical cap is not more effective than a diaphragm. The diaphragm does not require spermicide. Both may contribute to toxic shock syndrome. PTS: 1 DIF: Cognitive Level: Analysis REF: 694

23. A nurse is teaching a couple about basal body temperature. What information is most accurate? a.Measures the man's scrotal temperature related to sperm production. b.Basal body temperature is the average resting temperature in the woman. c.It detects slight temperature elevation just prior to ovulation in the woman d.Ovulation is the only event that affects the change in body temperature.

ANS: C This method assesses for the slight rise in temperature just prior to ovulation. It is done on the woman and not the man. Other factors such as illness and poor sleep can affect the reading.

18. In reviewing information related to the occurrence of pregnancies using a focus group discussion with women, concern was expressed that many of them had problems using their respective type of contraception and, as a result, became pregnant. Based on this information, the nurse would incorporate which of the following in a teaching plan for group members? a.Provide information relative to product recalls of contraceptive devices. b.Have the clients keep a contraceptive diary related to the consistency of using methods because it is apparent that they forgot to use their preferred method as directed. c.Have the clients consider switching to a different form of contraception because the contraception did not prevent pregnancy for them. d.Plan for assessing the clients' knowledge related to the contraception methods and provide information to increase the knowledge base so that the effectiveness rate would improve.

ANS: D A typical effectiveness rate refers to the occurrence of pregnancy while using contraception methods. If contraception is used correctly and consistently, pregnancy should not occur. A decreased effectiveness rate is associated with incorrect usage in terms of application or inconsistent use. Providing information relative to product recalls of contraceptive devices refers to an ideal effectiveness rate; the implication is that the contraception method, although used correctly, is at fault. There is no evidence to support this finding. Having the client keep a contraceptive diary does not address the primary concerns related to the typical effectiveness rate. Having the client switch methods may not be necessary because the primary focus is to determine the knowledge base and identify learning needs. PTS: 1 DIF: Cognitive Level: Synthesis REF: 683

3. Which client is a safe candidate for the use of oral contraceptives? a.39-year-old with a history of thrombophlebitis b.16-year-old with a benign liver tumor c.20-year-old who suspects she may be pregnant d.43-year-old who does not smoke cigarettes

ANS: D Heavy cigarette smoking is a contraindication. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant, preclude the use of oral contraceptives. Pregnancy is a contraindication. PTS: 1 DIF: Cognitive Level: Understanding REF: 689

2. A nurse is leading a discussion regarding birth control measures. Which method is considered the most reliable method? a.Coitus interruptus b.Breastfeeding c.Natural family planning d.Intrauterine device

ANS: D IUDs are 98% effective. Although coitus interruptus is considered 81% effective, it requires great control by the man and may be unsatisfying for both partners. Only women who breastfeed every 2 hours around the clock may avoid ovulation. Another method should be used when the frequency of breastfeeding decreases. Couples must be highly motivated to use natural family planning because they must abstain from sex for as much as half of their cycle. Errors in the forbidden time carry a very high risk of pregnancy. PTS: 1 DIF: Cognitive Level: Understanding REF: 682

13. A male client asks, "Why do I have to use another contraceptive? I had a vasectomy last week." The best response is: a."A vasectomy is only 85% effective." b."A vasectomy is not effective in all men." c."Semen may contain sperm for 6 months following a vasectomy." d."Complete sterilization doesn't occur until all sperm have left the system."

ANS: D It may take a month or longer for all sperm to be removed from the system. During that time, an additional method of contraception must be used. A vasectomy is more than 85% effective. Vasectomies have a high success rate but it may take 1 month for all the sperm to be removed from the system. After 1 month, all the sperm have usually been removed from the system. PTS: 1 DIF: Cognitive Level: Application REF: 687

9. Which response by the nurse is most appropriate when a client asks, "What contraceptive do you think I should use?" a."Ask your doctor. She will know what is best for you." b."The male condom is probably the easiest for you to use." c."Because you are younger than 40, you should use oral contraceptives." d."I can discuss the various methods with you so you can decide what is best."

ANS: D The nurse should provide the woman with all the necessary information to make an informed decision but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her. PTS: 1 DIF: Cognitive Level: Application REF: 680-682

4. The role of the nurse in family planning is to: a.refer the couple to a reliable physician. b.decide on the best method for the couple. c.advise couples on which contraceptive to use. d.educate couples on the various methods of contraception.

ANS: D The nurse's role is to provide information to the couple so that they can make an informed decision about family planning. The nurse can help the couple; they do not need to be sent to a physician. The nurse's role is to educate, not decide for the couple which is the best method or advise couples on which contraceptive to use. PTS: 1 DIF: Cognitive Level: Application REF: 686, 687

2. Conception in the first cycle of treatment for infertility has a success rate of 15% to 25%, falling as subsequent attempts are made. Is this statement true or false?

ANS: T Only 3% of couples conceive in the 12th cycle of treatment. Couples are often in a hurry for definitive therapy; however, a thorough assessment of the problem is essential for effective and financially sound treatment.

. 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.

B

14. 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 will be higher for you. c.The IUD will protect you from sexually transmitted diseases. d.Pregnancy rates are high with the IUDs.

B

16. 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 diseases as the diaphragm. d.Consent forms are not needed for IUD insertion.

B

5. 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 is 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.

B

8. The role of the nurse in family planning is to a.Advise couples on which contraceptive to use. b.Educate couples on the various methods of contraception. c.Decide on the best method of contraception for the couple. d.Refer the couple to a reliable physician.

B

21. 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 is lengthy and can be very costly. 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.

B Fertility assessment and diagnosis take time, money, and commitment from the couple.

15. 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

C

2. 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

C

6. 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

C Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year.

18. 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.FSH level d.Examination for testicular infection

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.

19. 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 that 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 obtaining an infant is very difficult.

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.

13. 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.

D