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

The nurse is assessing a male client who is concerned about his ability to produce enough sperm to have a child. He tells the nurse, "I have had some issues in my younger years." What questions would be important for the nurse to ask this client? Select all that apply. "Do you use drugs or use alcohol excessively? "Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?" "When was the last time you had sex?" "Do you have a regular girlfriend?"

"Do you use drugs or use alcohol excessively? "Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?"

A married couple, both age 27, is in the reproductive clinic and have been trying for a year to become pregnant. In a year, what percent of couples usually do conceive? 40 percent. 60 percent 90 percent 100 percent

90 percent

A nurse is visiting with a couple who has recently completed subfertility assessments and are awaiting the results. Throughout the conversation the wife intermittently begins to cry. What would be the most appropriate nursing diagnosis for this couple? Hopelessness related to perception of no viable alternative to usual conception Anticipatory grieving related to failure to conceive or sustain a pregnancy Situational low self-esteem related to the apparent inability to conceive Fear related to possible outcome of subfertility studies

Fear related to possible outcome of subfertility studies

The nurse is assessing a man concerned about his ability to father children because he has an "abnormality of the penis." The nurse finds that the urethral opening is on the ventral surface of the penis. How would the nurse document this finding? Epispadias Erectile dysfunction Cryptorchidism Hypospadias

Hypospadias

The nurse is conducting a health history on a couple planning to become pregnant over the next few months. Which statement by the male client most concerns the nurse? "I consume fast food a few times each week and enjoy a few beers on the weekends." "My uncle and his wife have not been able to conceive a child." "I have severe asthma and use my inhaler several times each month." "I have a degree as a chemical engineer and work at the local plant."

I have a degree as a chemical engineer and work at the local plant

Semen analysis has been ordered for the partner of a client who has been unable to become pregnant. What instructions should the nurse provide to the partner? "Collect the sample after two consecutive days of ejaculating." "Keep the sample refrigerated to ensure the sperm survive." "Bring the sample to the lab immediately after you collect it." "If possible, collect the sample first thing in the morning."

bring the sample to the lab immediately after you collect it

A client is being prepared for artificial insemination. Which finding is the most suggestive to determine if the client is ovulating? slight weight gain change in the cervical mucus abdominal cramps fall in body temperature

change in the cervical mucus

A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client? Record body temperature every night Record menses and time of intercourse Chart body temperature for at least a month Record body weight along with the temperature

chart body temperature for at least a month

A female client who comes to the clinic for a visit is diagnosed with Turner's syndrome. The nurse would expect the client to experience which of the following? Compromised or absent fertility Development of cystic fibrosis in male offspring Development of respiratory distress syndrome in her infant Maternal tubal problems

compromised or absent feritlity

A woman who has been trying to conceive has been diagnosed with multiple myomas of the uterus. What option is available for the woman to be able to conceive? Appendectomy Hysterectomy Myomectomy Salpingoophorectomy

myomectomy

A couple informs the nurse that they have not been able to conceive for the last year. During assessment, the nurse learns that the couple has a 3-year-old daughter and 7-year-old son. They report having had no problems getting pregnant the other times. Which type of fertility is this couple exhibiting? primary subfertility secondary subfertility fertility sterility

secondary subfertility

A female patient had a diagnostic laparoscopy and is now reporting a sharp pain in her shoulder. What response is a priority by the nurse? The patient is probably having a pulmonary embolus and should be administered anticoagulation drugs immediately. The patient may be having a myocardial infarction from the stress of the procedure and the nurse should begin cardiac protocols. Some of the carbon dioxide that was used to insufflate the abdomen has likely escaped under the diaphragm and this will resolve on its own. The patient has possibly developed aspiration from stomach contents related to anesthesia.

Some of the carbon dioxide that was used to insufflate the abdomen has likely escaped under the diaphragm and this will resolve on its own.

A client is to take clomiphene citrate for infertility. Which outcome should the nurse explain is the expected action of this medication? Reduce inflamed endometrium Break down scar tissue Stimulate the release of ova Decrease testosterone levels

stimulate the release of ova

A 23-year-old client who's 27 weeks pregnant arrives at her physician's office with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. Which condition would the nurse most likely suspect? Asymptomatic bacteriuria Bacterial vaginosis Pyelonephritis Urinary tract infection (UTI)

pyelonephritis

A client is scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs? Orchitis Nausea Priapism Weight gain

priapism

A couple who has not conceived after 6 years of not using birth control are being seen in the infertility clinic. In assessing the client's psychosocial response to infertility, which might the nurse expect to find? Select all that apply. Excitement at the possibility of conceiving Sexual stimulation and excitement Guilt related to the lack of conception Anger toward others who have conceived Fear of the possible outcome of the testing

Guilt related to the lack of conception Anger toward others who have conceived Fear of the possible outcome of the testing

A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications? Walk several times a week, maintain a regular sleep schedule, decrease complex carbohydrates, and avoid complex sugars. Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule. Walk every day, increase caffeine and salt intake, and sleep 8 to 10 hours a night. Reduce caffeine, perform cardio exercise 3 times a week, and sleep 12 hours every other night.

Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule.

A 35-year-old female client who is unable to conceive is scheduled for a hysterosalpingogram to assess tubal patency. Which of the following would the nurse ensure before the client undergoes the hysterosalpingogram? Client has been administered general anesthesia Client is in second phase of menstrual cycle Client's basal body temperature is recorded Client has just completed her menses

client has just completed her menses

A nurse should instruct a client who has secondary erectile dysfunction related to type 2 diabetes to make which lifestyle modification? Control blood sugars Lose weight Reduce blood pressure Reduce stress

control blood sugars

A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply. ovulation tubal transport diabetes impaired implantation lack of exercise

ovulation tubal transport impaired implantation

A female client complains of irregular menses. On further assessment, the nurse observes that the client is obese and is developing hirsutism. Her diagnosis indicates an ovarian dysfunction with increased levels of testosterone. The nurse interprets these findings to suggest: premature ovarian failure. polycystic ovarian syndrome. hypothyroidism. adrenal hyperplasia.

polycystic ovarian syndrome.

The nurse has been working with a subfertile couple through the process of determining their best plan of action to conceive a child. Which action should the nurse prioritize to provide emotional support to this couple? Speak only with both partners present so they will feel more comfortable. Speak separately with each partner so both will feel more free to talk. Speak both separately and together with both partners. Only speak with the woman, who is the client.

speak both separately and together with both partners

A couple consults with the nurse regarding their infertility issues. The female says "I don't know what I have done so bad that God would punish me like this." What would be the most appropriate nursing diagnosis for this couple? Spiritual distress related to inability to conceive Hopelessness related to inability to conceive Powerlessness related to infertility Anticipatory grieving related to infertility

spiritual distress related to inability to conceive

A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions? "I will be put under general anesthesia for the procedure." "They will place a catheter in my uterus and use an ultrasound to see what the problem is." "This is just an ultrasound procedure, like they do for a baby." "They will surgically implant the ovum during the procedure."

they will place a catheter in my uterus and use an ultrasound to see what the problem is

A 25 year old having a yearly check-up informs the nurse that she has stopped taking birth control pills 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? "The chance of subfertility increases with age, especially after the age of 20." "Women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them." "Based on your history, you probably won't experience a problem getting pregnant." "It seems that everybody is different when it comes to getting pregnant."

women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them

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 uterine endometrial biopsy a sonohysterography a hysterosalpingography a hysteroscopy

a hysterosalpingography

A young woman is having trouble conceiving and has come in to the office for fertility testing. She states that she has irregular and unpredictable menstrual cycles. On blood testing, it is found that her ovaries are producing excess testosterone, which is lowering her follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Which of the following is the most likely cause of her subfertility? Anovulation Endometriosis Tubal transport problems Stenotic cervical os

anovulation

A female client reports difficulty becoming pregnant despite having coitus daily for the past 2 months. Which advice will the nurse recommend? "Elevate your hips on a small pillow after coitus to improve sperm motility." "Douche immediately after coitus to push the sperm through the cervix." "You should begin considering in vitro fertilization." "Avoid having coitus every day because this may lower your partner's sperm count."

avoid having coitus every day because this may lower your partners sperm count

A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? "A genetic abnormality may cause infertility." "An absence of ovulation may cause infertility." "Diet does not play a role in infertility." "Exercise can influence infertility."

diet does not play a role in infertility

Inability to conceive can be very stressful on a couple. What is one psychological aspect of infertility? Emotional stability Growth of intimacy Couple becomes closer Loss of intimacy

loss of intimacy

A couple comes in and tells the nurse that they have been trying diligently to conceive for the last 3 months and are subfertile. What should the nurse explain to the couple about the definition of subfertility? Subfertility is said to exist when a pregnancy has not occurred after at least 3 months of engaging in unprotected coitus. Subfertility is said to exist when a pregnancy has not occurred after at least 6 months of engaging in unprotected coitus. Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus. Subfertility is said to exist when a pregnancy has not occurred after at least 2 years of engaging in unprotected coitus.

Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus.

A couple has just undergone a semen analysis. The semen sample was visualized under the microscope, and the nurse tells the couple that they must return to do another semen analysis. The man states that he can return later in the week. What is the best answer the nurse can provide? The analysis will need to be repeated after 1 or 2 months because spermatogenesis is an ongoing process, and 60 to 90 days are needed for sperm to reach maturity. The analysis will need to be repeated after 1 or 2 months because spermatogenesis is an ongoing process, and 30 to 60 days are needed for sperm to reach maturity. The analysis will need to be repeated after 2 or 3 months because spermatogenesis is an ongoing process, and 15 to 30 days are needed for sperm to reach maturity. The analysis will need to be repeated after 2 or 3 months because spermatogenesis is an ongoing process, and 30 to 60 days are needed for sperm to reach maturity.

The analysis will need to be repeated after 2 or 3 months because spermatogenesis is an ongoing process, and 30 to 60 days are needed for sperm to reach maturity.

The experienced nurse working in a fertility clinic understands the stress couples experience when they have to "schedule" sexual relations. Which suggestion would be most helpful to a couple to help prevent further stress on their relationship? Try to relax and enjoy it. Begin a new activity together. Take up new individual hobbies. Avoid talking about the cost that is involved.

being a new activity together

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? Abstain from sexual intercourse Wear cotton underwear Clean from back to front after urination Restrict the intake of salt in the diet

wear cotton underwear

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

FSH

The nurse is providing care to a female client and spouse who has completed several rounds of unsuccessful in vitro fertilization. The client still desires to have a child. Which response by the nurse is appropriate? "It would be wise for you and your spouse to consider life without children." "Have you and your spouse considered using a surrogate mother?" "I recommend you continue trying in vitro fertilization if you desire to have a child." "Can you tell me more about your desire to have children?"

"Have you and your spouse considered using a surrogate mother?"

A couple in their early 30s is concerned because they have been trying to get pregnant for 4 months without success. The woman says that she had been on oral contraceptives before they began trying. Which of the following should the nurse say to the couple? "Oral contraceptives may delay conception for a few months. Give it another 6 to 8 months." "You are experiencing subfertility. Increase your frequency of coitus to every day." "You are experiencing sterility. Have you considered adoption or child-free living?" "You are experiencing subfertility related to your age. I recommend beginning fertility testing next week."

"Oral contraceptives may delay conception for a few months. Give it another 6 to 8 months."

A nurse is reviewing sperm count results for a couple trying to conceive. Which results would concern the nurse? 10 million per ml of seminal fluid 20 million per ml of seminal fluid 30 million per ml of seminal fluid 40 million per ml of seminal fluid

10 million per ml of seminal fluid

The nurse is assessing a young couple who desire to get pregnant. The 38-year-old husband and 29-year-old wife report they had used oral contraceptive pills (OCPs); however, they have now been trying unsuccessfully to conceive over the past 4 months. What is the best response for the nurse to make? Return in 9 months for further assessment if not pregnant. Should seek fertility counseling from a specialist. Increase intercourse frequency to four times a week around the time of ovulation. Should undergo comprehensive diagnostic testing.

increase intercourse frequency to four times a week around the time of ovulation

A woman and her partner have been unable to conceive. The female client's chart reveals a history of pelvic inflammatory disease (PID), oral contraceptive usage for 5 years, blood pressure 98/72 mm Hg, pulse 78 beats/min, temperature 99°F (37.2°C), and white blood cell (WBC) count 9,500 mm3 (9.5 x 109/l). Which order will the nurse anticipate for this client? hysterosalpingography serum estrogen and progesterone testing urinalysis oral antibiotic therapy

hysterosalpingography

A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make? "Adoption is always an acceptable option for anyone." "I will call the health care provider to come visit with you." "The use of surrogates is more acceptable today." "Being childless is not as bad as you think it is."

i will call the health care provider to come visit with you

A nursing instructor is teaching about fertility and realizes a need for further instruction when a student states: "Sterility is the inability to conceive because of a known condition, such as absence of a uterus." "In most couples with a subfertility problem, it is the man who is subfertile." "In primary subfertility, there have been no previous conceptions." "In secondary subfertility, there has been a previous viable pregnancy."

in most couples with a sub fertility problem it is the man who is subfertile

A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client? Gamete intrafallopian transfer In vitro fertilization Surrogate mother Ovulation stimulation

in vitro fertilization

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 is time to talk to your health care provider about hormone testing." "Do you or your partner have a family history of subfertility?" "The problem can be with the man, woman, or both. We will explore all possibilities." "It can take up to 1 year of regular, unprotected intercourse to conceive."

it can take up to 1 year of regular, unprotected intercourse to conceive

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? overstimulation of the ovary resulting in potential multiple births extensive bleeding during menstruation elevation of her blood glucose level hypertension

overstimulation of the ovary resulting in potential multiple births

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply. in vitro fertilization counseling fertility drugs semen analysis ovulation monitoring tubal patency

ovulation monitoring tubal patency semen analysis

A 28-year-old married female client is planning to delay attempting pregnancy for another 10 years and is eager to know if there will be any complications involved. Which of the following information should a nurse provide to this client regarding delaying pregnancy? Risk of low blood pressure increases with age Risk of pregnancy complications decreases Quality and number of ova declines with age Immune system weakens with age

quality and number of ova declines with age

A male patient comes to the clinic and informs the primary care provider that he and his wife are trying unsuccessfully to conceive. He adds that he cannot get an erection and believes this problem started when he began taking blood pressure medicine. What type of erectile dysfunction would be suspected? primary erectile dysfunction secondary erectile dysfunction tertiary erectile dysfunction sterility

secondary erectile dysfunction

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? semen analysis, ovulation monitoring, and tubal patency assessment semen analysis, urinalysis, and ovulation monitoring serologic test for syphilis, semen analysis, and tubal patency assessment pelvic sonogram, ovulation monitoring, and semen analysis

semen analysis, ovulation monitoring, and tubal patency assessment

A couple has come to the infertility clinic because they have been unable to get pregnant even though they have been trying for over a year. Diagnostic tests are planned for the woman to ascertain if ovulation is regular and whether her endometrium is adequately supported for implantation. What test would the nurse expect to have ordered for this woman? Serum progesterone Ovulation list Oocyte viability test Urine testosterone

serum progesterone

A young couple is having difficulty getting pregnant. The nurse is preparing the couple for the initial tests to determine their fertility. When asked by the couple why they need to start with a sperm analysis, what will be the nurse's best response? Asking the male to undergo diagnostic procedures first is the best way to assess interest in treatment of infertility. The man is found to be fertile in over 75 percent of couples with infertility problems. Male fertility testing is time-consuming and therefore should be initiated early. Sperm analysis is one of the easiest tests to complete.

sperm analysis is one of the easiest tests to complete

A couple comes to the clinic and informs the nurse that they have been trying to conceive for 6 months with no success. The husband states that they have coitus at least 5 or 6 times per week to optimize their chance of success. What can the nurse educate the couple about frequency of coitus? The couple should continue to have unprotected coitus daily to improve the chance of conception. The couple should have coitus only when the female partner is ovulating. The couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count. The male partner should check his sperm count each time he has coitus to ensure an adequate count.

the couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count

A woman trying to conceive has been prescribed metronidazole for bacterial vaginosis. What should the nurse caution this client while taking this medication? The medication will be continued to treat the infection. She will be monitored closely if she discovers she is pregnant. This medication is safe for use in pregnancy. This drug is the only treatment for bacterial vaginosis and must be taken as prescribed even if pregnancy is suspected. This drug can be teratogenic early in pregnancy and she should inform the health care provider if pregnancy is suspected.

the drug can be teratogenic early in pregnancy and she should inform the health care provider if pregnancy is suspected

A client is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that she needs further teaching? "The primary care provider will transfer my fertilized eggs into the uterus." "The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." "I will receive fertility drugs to stimulate ovulation." "The primary care provider will harvest eggs from my ovary."

the primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized

A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client? the vas deferens the epididymis the ejaculatory ducts the scrotum

the vas deferens