Chapter 7: Nursing Care of the Family Having Difficulty Conceiving a Child

A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications?

Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule. Explanation: A healthy lifestyle contributes to a general sense of well-being. Encourage regular exercise, reduction or elimination of caffeine and alcohol, and adequate and regular sleep.

A female client is having a procedure this morning that involves radiologic examination of the fallopian tubes using a radiopaque medium. What procedure should the nurse document as being performed?

a hysterosalpingography Explanation: A hysterosalpingography, a radiologic examination of the fallopian tubes using a radiopaque medium, is a frequently used technique.

A healthy 28-year-old female client is planning a pregnancy with the support of a female partner. What does the nurse anticipate will be the first method of assisting this client to achieve a pregnancy?

artificial insemination Explanation: For a healthy female client with no known challenges with fertility, artificial insemination with donor sperm is the most affordable and least invasive approach to achieving a pregnancy. The other methods listed will be considered if artificial insemination is not effective.

About which childhood communicable disease should the nurse question the male client who is seeking information about subfertility?

mumps Explanation: Diseases such as mumps orchitis (testicular inflammation and scarring because of the mumps virus) can result in obstruction.

A female client has been trying to conceive for 3 months. She tells the nurse, "I just know something is wrong with me." Which response by the nurse is best?

"It can take up to 1 year of regular, unprotected intercourse to conceive." Explanation: The nurse would first provide accurate information by informing the client that 3 months is not an adequate time frame to indicate a problem is present. Most couples conceive within 1 year when they have regular intercourse without the use of contraceptives. There is no reason to assess for infertility issues with the female or with the couple's families. It is true that subfertility issues can be related to the man, woman, or both; however, it is not appropriate to indicate there is concern by stating "we will explore all possibilities."

A 38-year-old client wishes to discontinue use of oral contraceptive pills (OCPs) and attempt to conceive. The client says to the nurse, "I know a lot of women who have waited later to have children and became pregnant easily." How will the nurse respond?

"Women in their late 30s who use oral contraceptive pills may face a delay in conception, as the body takes a few months to be able to conceive." Explanation: Age impacts the ability to conceive. The chance of subfertility increases with age. Because of this gradual decline in fertility, women who defer pregnancy to their late 30s are apt to have more difficulty conceiving than their younger counterparts. Clients using oral, injectable, or implanted hormones for contraception may have difficulty becoming pregnant for several months after discontinuing these medications as the body needs time to restore normal functioning.

Which laboratory result would be most important for a nurse to monitor for a client who has recently started letrozole?

FSH Explanation: The nurse will need to monitor FSH levels in the client taking letrozole to increase ovulation.

A client is to take clomiphene citrate for infertility. Which outcome should the nurse explain is the expected action of this medication?

Stimulate the release of ova Explanation: Clomiphene citrate stimulates the release of FSH and LH which is responsible for the maturity and release of ovum from the ovary

A male client visits a fertility clinic after one year of attempting unsuccessfully to impregnate his wife. What is a risk factor associated with male infertility?

no or few sperm cells produced Explanation: Azoospermia or oligospermia (no or few sperm cells produced) is a risk factor affecting male infertility. Normally, the volume of semen ejaculated needs to be about 2-5 ml, with a density of sperm at about 20 million/ml. In addition to the number of sperm, the motility (movement), viability, and morphology (shape) of the sperm must be within normal limits.

A 25-year-old having a yearly check-up informs the nurse that she has stopped taking oral contraceptive pills (OCPs) because she and her husband want to start a family. She states, "I know I will get pregnant right away because my mother was very fertile." What is the nurse's best response?

"Women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them." Explanation: Although the chance of subfertility increases with age, this client is 25 years old, so that issue does not apply. The nurse should inform her that after stopping oral contraceptive pills it may take several months for the body to restore normal functioning, so it may take time to conceive. The other statements are not appropriate. Although each person is an individual, the statement about everybody being different offers false reassurance and does not address the client described in the scenario.

A client states she has purchased home-use ovulation strips to help her know when she is ovulating. Which response by the nurse is most appropriate?

"You can also test your vaginal discharge to determine if you are ovulating." Explanation: The appropriate statement for the nurse to make is regarding testing vaginal or cervical discharge (spinnbarkeit test). This testing and basal body temperature monitoring are free methods clients can use at home to test for ovulation. The home-use ovulation kit monitors luteinizing hormone (LH) levels in a urine sample. The home-use kit monitors for a surge in LH that would indicate ovulation is getting ready to occur. They are typically effective; however, they can be expensive to use repeatedly. Although being tested in the clinic would be most accurate, this is not feasible for most clients financially nor easy to fit into daily schedules. The nurse would not provide false assurance that usage will lead to a quick pregnancy as other factors could be present.

A 32-year-old male client comes to the clinic for a refill of the antihypertensive medication atenolol. The client tells the nurse that since taking the medication, they have had difficulty maintaining an erection. Which follow-up question is most important?

Do you take the medication as prescribed? Explanation: All of the questions are beneficial to understanding the experience of the client and identifying what the next steps may be. Erectile dysfunction is a side effect of the antihypertensive medication. It is a primary cause of male clients discontinuing or decreasing the medication from the prescribed dose. It is most important for the nurse to ascertain if one of these actions is occurring, because that information affects client health, client education, and any medication adjustment by the health care provider. Thus, the question to asked would be, "Do you take the medication as prescribed?" If not, the client should be directed immediately to notify the health care provider, so that a different type of antihypertensive could be prescribed. Typically antihypertensive medications are taken in the morning with blood levels maintained throughout the day. The client is to take the medication at the same time daily. How long the medication has been taken is not as important to assess as making sure that the client continues to take the medication. It is important to refer the client back to the health care provider. Once the health care provider has these data, a medication change may be made.

What intervention will the nurse perform for a couple trying to work through the stress that fertility testing is placing on their lives?

Encourage them to join a support group for infertile couples. Explanation: It is the nurse's responsibility to assess the clients' emotional state and make nursing suggestions or referrals which the nurse feels will be helpful. Participation in a support group may allow a couple to work through the stress that fertility testing places on their lives. Resolve (http://www.resolve.org), a national support group for couples with infertility, can be helpful in offering referral sources and support that a couple can use in planning. Informing them that the staff cares is supportive but does not help with the stress that fertility testing places on the couple. Reminding them of patience is not helpful and condescending. Referring to a psychiatrist makes it appear that the clients' feelings are not appropriate.

A 40-year-old female client with a chronic pelvic infection expresses her desire to conceive post-treatment. When discussing this with the client the nurse keeps in mind that the client is at increased risk for which of the following?

ectopic pregnancy Explanation: Chronic pelvic infection increases the risk for narrowed or blocked fallopian tubes. It decreases the possibility of fertility or increases the risk of ectopic pregnancy. Only in case of a premature ovarian failure will the client experience symptoms of menopause earlier than expected. A client with hyperthyroidism will experience decreased or absent menses. The client with chronic pelvic infection is not susceptible to gestational diabetes. Clients with multiple gestations are more susceptible to gestational diabetes.

A pregnant client has been diagnosed as having a urinary tract infection (UTI). Which of the following instructions regarding control of the infection should the nurse provide the client?

wear cotton underwear Explanation: The nurse should instruct the pregnant client with a urinary tract infection to avoid irritation of the perineal area by wearing cotton underwear instead of synthetic ones. Abstinence from sexual activity is not needed in such a case. The client should be advised to wipe from front to back after sexual intercourse and urination. For good perineal hygiene, the nurse should instruct the client to clean her perineum in a front-to-back direction, and not from a back-to-front direction. Restriction of salt intake may be necessary for the treatment of hypertension, but not urinary tract infection.