Family Planning

spermicide

A chemical that kills sperm

fetal chromosome defects (Errors in the fetal chromosomes may result in spontaneous abortion, usually in the first trimester. Lack of FSH and dysfunction of the pituitary gland are causes of disorders in ovulation; tubal obstruction prevents implantation)

A couple is in for fertility counseling. They have achieved pregnancy six times, but have lost each pregnancy before the 20th week of gestation. The nurse is aware that the most common cause of repeated pregnancy loss is: a. lack of FSH hormone. b. tubal obstruction. c. dysfunction in the pituitary gland. d. fetal chromosome defects.

gestational surrogate

A woman who provides the use of her uterus to an infertile couple who supplies the egg and sperm is known as a

basal body temperature

Body temperature at rest

tubal ligation

Cutting the fallopian tubes to prevent passage of ova and sperm

oligospermia

Decreased number of sperm in semen

inform the woman that the patch should not be applied to the breast. (The patch can be applied to the abdomen, buttocks, or upper arm. It should not be applied to the breast area or areas that are rubbed by straps or waistbands.)

During a breast exam the midwife notes the woman has a transdermal contraceptive patch applied to the breast. The midwife should: a. document the appropriate use of the patch. b. question the woman on her satisfaction with the patch. c. inform the woman that the patch should not be applied to the breast. d. remove the patch to complete the breast exam.

semen analysis

Generally, the first test to be performed on a male when infertility issues are present is a

At approximately the same time each day

How should a woman take oral contraceptives? a) On an empty stomach, with a full glass of water b) At approximately the same time each day c) Before every episode of intercourse d) In the morning and at bedtime

See her physician and use another method of contraception

If the IUD strings are longer than usual, the woman should: a) Know that this is expected when the IUD is first inserted b) Immediately have a Pap smear to rule out cervical cancer c) Take her temperature twice a day for a week d) See her physician and use another method of contraception

infertility

Inability to conceive after 1 year

endometriosis

Presence of endometrial tissue outside the uterine cavity

should be wet with water before it is used

Teaching for a woman using the contraceptive sponge includes telling her that the sponge a. must be replaced for repeated intercourse b. can be left in place for up to 48 hours c. should be wet with water before it is used d. should remain in place for at least 4 hours

Reduces transmission of infection

The major advantage of using a condom for contraception is that it a) Does not require monthly injections b) Reduces transmission of infection c) Can be placed several hours before intercourse d) May be incorporated as part of foreplay

use a spermicide (Using spermicides with condoms increases lubrication, which decreases the risk of condom breakage. Effectiveness is increased when spermicides are used with condoms.)

To increase the effective rate of male condoms, the female partner may: a. douche after intercourse. b. use a spermicide. c. use a female condom. d. use an oil-based lubricant.

D, E (Spermicides and condoms may be purchased over-the-counter and do not require a prescription or clinic visit.)

When counseling teenagers about contraception, it is important to teach them methods that do not require a clinic visit to obtain. One method that does not require a clinic appointment or prescription is: a. vaginal ring. b. intrauterine device. c. diaphragm. d. spermicides. e. condoms

myoma

benign muscle tumor

postcoital test

evaluation of cervical mucus and sperm function after intercourse at the time of ovulation

hysterosalpingography

imaging study to evaluate the structure and patency of the uterus and fallopian tubes

pregnancy wastage

repeated loss of pregnancy before the fetus is mature enough to survive

hypospadias

urethral opening on the underside of the penis

would require that she return to the clinic every 3 months (Depo-Provera is an injectable progestin that prevents ovulation for 12 weeks. This requires the woman to return to the clinic every 3 months for the injection.)

A 26-year-old woman is considering medroxyprogesterone acetate (Depo-Provera) as the form of contraception that is best for her. To assist this woman with decision making concerning this method of contraception, the nurse would tell her that Depo-Provera: a. is inserted subcutaneously into the upper inner arm. b. would require that she return to the clinic every 3 months. c. should not be used if she has a history of estrogen-sensitive cancer. d. is effective for 3 years.

He was infected with mumps 2 years ago after the birth of his girl (Acute or chronic illness such as mumps, cirrhosis, or renal failure can impair the number and function of the sperm. Sitting for prolonged periods will elevate the scrotal temperature and impair the number and function of the sperm. Antihypertensives may produce abnormal ejaculation but not interfere with the sperm number and function.)

A couple delivered a full-term baby girl 3 years ago. They have been attempting pregnancy for the past 2 years without success. When taking a history from the couple, which of the following may lead to abnormal sperm number and function in the male? a. His job requires him to walk most of the day with few rest periods. b. He was infected with mumps 2 years ago after the birth of his girl. c. He was diagnosed with hypertension 2 years ago and is under medical treatment. d. His job requires him to be outside about 7 hours out of the 8 hours at work.

infertility care does not always lead to a successful pregnancy (Because some factors contributing to infertility remain unknown, treatment of an identified problem does not always lead to a successful pregnancy.)

A couple seeking infertility counseling expresses their excitement by stating: "Now at last we can become pregnant; we are so glad to get this process started!" The response by the nurse should be based on the knowledge that: a. infertility care does not always lead to a successful pregnancy. b. a successful pregnancy chance can be increased with intervention. c. infertility counseling just looks at the cause of the infertility, not to treat. d. a pregnancy can be increased, but there is no guarantee to the successful completion of the pregnancy.

that progestin-only contraceptives may be started 6 weeks after birth (Combination oral contraceptives reduce milk production in lactating women, and very small amounts may be transferred to the milk. Progestin-only contraceptives may be a better choice if a woman wishes to use a hormonal contraceptive because they do not affect milk production. They are often started 6 weeks after birth.)

A lactating woman asks the nurse about contraception. She states she has always used a combination pill and would like to continue with that method. The nurse should advise the woman: a. that oral contraceptives are contraindicated during the lactation period. b. that progestin-only contraceptives may be started 6 weeks after birth. c. that combination contraceptive pills may be started 3 to 4 weeks after birth. d. only barrier methods are recommended during the lactation period.

during the postpartum period prior to being discharged from the hospital (A tubal ligation can be performed soon after birth. It can be done at the same time as a cesarean birth or planned before discharge.)

A pregnant woman has requested a tubal ligation for contraception. The nurse is aware that this surgery can occur: a. during pregnancy. b. during the postpartum period prior to being discharged from the hospital. c. 6 weeks postpartum. d. 6 months postpartum.

therapeutic insemination (Therapeutic insemination may use semen of a donor. This can be used if a woman wants a biological child without having a relationship with a male partner.)

A woman and her female partner have come to the clinic stating they would like to have a baby. During the interview the nurse discusses the possibilities with the couple. One possibility in which the woman may conceive and deliver her biological child is: a. egg donation. b. therapeutic insemination. c. surrogate parenting. d. ovulation induction.

comfort level on self-insertion of the ring every 3 weeks (The woman must remove the ring after 3 weeks and insert a new ring 1 week later. The woman must be comfortable inserting the device into the vagina.)

A woman asks the nurse about the "new vaginal ring everyone is talking about for birth control." When counseling the woman about this method of contraception, the nurse should assess for the woman's: a. ability to remember to insert the device every morning. b. feelings about having to insert the device before sexual intercourse. c. comfort level on self-insertion of the ring every 3 weeks. d. ability to return to the clinic once a month for reinsertion.

within 5 days after her next menstrual period (The injection is best given within 5 days of the menstrual period. If given later in the cycle, an additional form of contraception should be used for the first week.)

A woman called the clinic desiring to start on medroxyprogesterone acetate (Depo-Provera) for contraception. The nurse should make an appointment for the woman: a. immediately b. within 5 days after her next menstrual period. c. prior to her next menstrual period. d. at the time of ovulation.

on Monday (The effectiveness of emergency contraception is greatest if used within 72 hours of unprotected intercourse.)

A woman calls the clinic early on a Monday morning stating she needs a prescription for emergency contraception. Upon questioning by the nurse the woman states her boyfriend's condom was displaced during intercourse on Saturday night. The nurse should make an appointment for the woman: a. on Monday. b. by Wednesday. c. by Thursday. d. no later than Friday.

certain oral contraceptive pills may be taking consequently for 2 months to delay menses (When women prefer extended cycles in which menses is delayed for a few days for special occasions or for a longer time, they take two or more oral contraceptive pill packs without taking the placebo pills for several packs or indefinitely.)

A woman comes to the clinic stating she is going on a hiking trip that will last 2 months. She states: "I have heard there are things that can be done to prevent me from having a period for that time frame." The nurse's response should be based on the knowledge that: a. there is no healthy way to skip a menstrual period. b. there is a surgery, similar to a dilation and curettage, that can be done prior to the hiking trip. c. certain oral contraceptive pills may be taking consequently for 2 months to delay menses. d. there is a type of oral contraceptive pill that may give an extended menses for 1 month and the next month's will be lighter.

use another form of contraception for the first week

A woman decides to change from the diaphragm to depo-provera. Her last menstrual period ended 1 week ago. She should be taught that she should a. take an oral contraceptive during this cycle only b. return in 1 week to have the hormone injection c. use another form of contraception for the first week d. expect more regular periods than when using the diaphragm

does not render a man sterile for about 3 months (Following a vasectomy, complete sterilization does not occur until sperm are no longer present in the semen. This may be 3 months or more.)

A woman has just been diagnosed as being 2 months pregnant. She is upset and states: "This is not possible, my husband had a vasectomy 3 months ago and he should be sterile." The nurse should respond to this woman with the knowledge that a vasectomy: a. is not effective in all men. b. can undo itself within the first 3 months after surgery. c. does not render a man sterile for about 3 months. d. does produce sterility; therefore there should be another explanation concerning the pregnancy.

inform the surgeon of the woman's feelings (Sterilization should be considered a permanent end to fertility because reversal surgery is difficult, expensive, not always successful, and often not covered by insurance. The nurse should act as an advocate for the woman, by informing the surgeon that the woman is having second thoughts about the surgery. Even though the consent forms have been signed, the woman does not have to proceed with the surgery.)

A woman is being admitted to the outpatient surgical unit for a tubal ligation. She states to the nurse: "I know I have to go through with the surgery since I have already signed all the papers, but I was thinking this morning how wonderful it would be to have another baby." The nurse's next action should be to: a. inform the woman that the surgery unit has already been prepared and that it would be expensive to cancel the surgery at this time. b. inform the woman that the surgery can be reversed at a later date if she should change her mind. c. inform the surgeon of the woman's feelings. d. document the conversation and continue to prepare the woman for surgery.

13 to 15 (Ovulation occurs approximately 14 days before the onset of menses.)

A woman is being counseled concerning the calendar method type of natural family planning. The woman states her cycles run from 27 to 29 days. The nurse teaches the woman that ovulation will probably occur on about days: a. 10 to 12. b. 13 to 15. c. 16 to 18. d. 18 to 20.

gestational surrogate (A surrogate mother in a gestational surrogate pregnancy supplies her uterus only, with the infertile couple supplying the sperm and ovum. The other choices all require a functioning uterus in the biological mother.)

A woman is born without a functioning uterus but functioning ovaries. She and her husband come to the infertility clinic requesting info on the possibility of having a baby. One possibility for this couple to have a biological child is: a. in vitro fertilization. b. therapeutic insemination. c. gestational surrogate. d. gamete intrafallopian transfer.

The procedure should be considered permanent and irreversible

A woman is considering having a tubal ligation after she gives birth to her second child. The nurse should counsel her that a) She should wait until several months after birth to be certain the infant is healthy b) The procedure should be considered permanent and irreversible c) Sterilization is easier to perform 1 month after the postpartum period d) She must sign informed consent by the sixth month of pregnancy

a male condom (The male condom offers the best protection from sexually transmissible diseases because it's a barrier.)

A woman is requesting information concerning contraception. She is sexually active with multiple partners and is concerned about sexually transmissible diseases. When doing client teaching, the nurse should be aware that the contraceptive method that offers the most protection against sexually transmissible diseases is: a. oral hormones. b. an intrauterine device. c. a male condom. d. natural birth control.

that the woman should use another form of birth control for 3 months after the procedure (With the Essure procedure a tiny coil is inserted into each fallopian tube. The tubes become permanently blocked during the next 3 months as tissue grows into the inserts. During this time another contraceptive method is used. The procedure can be performed in the physician's office. It is a nonsurgical method of sterilization.)

A woman is to have an Essure performed to produce sterilization. The nurse should include in the client teaching: a. that this procedure requires minor surgery and that it will be done in the outpatient surgical unit. b. that the woman should use another form of birth control for 3 months after the procedure. c. that he woman should rest for 24 hours after the procedure and should not lift heavy objects for a week. d. that narcotic analgesics will be prescribed for pain control after the procedure.

Swelling and pain in one of her legs (Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. The other answer choices are all expected side effects of oral contraceptive pills, and temporary in nature, and usually subside within a few cycles.)

A woman taking an oral contraceptive as her birth control method of choice should notify her health care provider immediately, if she notes which of the following? a. Breast tenderness and swelling b. Weight gain c. Swelling and pain in one of her legs d. Mood swings

intrauterine device (Once they are inserted, IUDs provide long-term, continuous contraception without the need to take pills, have injections, or perform other tasks before or during intercourse. They are appropriate for many women who cannot use hormonal contraception such as a history of blood clots. They are safe for use during lactation. Tubal ligation should be considered a permanent procedure; the woman did not request that type of contraception.)

A woman who is 6 weeks postpartum & lactating is being counseled about contraception. She states she desires to have a type of birth control that she does not have to "think about." She has three children, so it should be effective & she is in a monogamous relationship. She has a history of blood clots. One appropriate choice of birth control that the nurse can recommend is: a. combination pill. b. male condoms. c. tubal ligation. d. intrauterine device.

have her come to the clinic promptly for a sensitive pregnancy test.

A woman who is taking clomiphene citrate (Clomid) calls the infertility clinic and says that she has some nausea each morning and frequency of urination. She suspects that she may be pregnant. The correct nursing response is to: a. tell her that pregnancy cannot be determined until she misses her next period. b. have her come to the clinic promptly for a sensitive pregnancy test. c. have her continue taking the drug until she completes this cycle and then have a pregnancy test. d. reassure her that her symptoms are commonly seen in women who take this drug.

the possibility of adoption (Not every couple who seeks treatment for infertility achieves a "take-home" baby. Adoption may become an option for these couples. The nurse can assist them to explore their personal feelings about adoption, availability of newborns compared with older children, and the pros and cons of adoption.)

After 2 years of infertility treatment a couple decides they cannot financially go through any more treatments. When discussing this decision with the couple, the nurse can discuss with them: a. the possibility that accepting the fact they may not have a child will cause them to relax and maybe conceive. b. how to accept the fact they may never have a child. c. the possibility of adoption. d. the possibility of accepting a niece or nephew as a surrogate child.

"This must be very frustrating to you." (Infertility treatment is stressful. The woman may experience depression and guilt. The best response by the nurse is to allow the woman time to express her concerns and feelings.)

After a year of infertility treatment a woman just began another menstrual period. She tells the nurse, "I am so tired of trying. It feels like I will never have a baby; I just am not a true woman." The best response by the nurse would be: a. "Remember not everyone receiving treatment will become pregnant. We told you that at the very beginning of the treatments." b. "Don't give up yet; you are still young and we are learning newer techniques to try every day." c. "This must be very frustrating to you." d. "Having a baby does not make you a woman."

induce ovulation (Clomiphene citrate is used to induce ovulation in women who have specific types of ovulatory dysfunction. Bromocriptine (Parlodel) corrects excessive prolactin secretion. Gonadotropin-releasing hormone (GnRH) antagonists reduce endometriosis. GnRH stimulates the release of FSH and LH.)

After an infertility assessment, a woman receives a prescription for clomiphene citrate (Clomid). The nurse should teach the woman that this medication is used to: a. correct excess prolactin secretion. b. reduce endometriosis. c. stimulate the release of FSH and LH. d. induce ovulation.

a complete history and physical assessment of both partners (Assessment for the origin of infertility always begins with the least costly, noninvasive testing first. A complete history and physical assessment of both the male and female recognizes that infertility can have a female or male origin, or both. This assessment will provide clues as to which types of tests, if any, would be most appropriate for this couple.)

Assessment of a couple experiencing difficulty conceiving usually begins with: a. a complete history and physical assessment of both partners. b. semen analysis. c. testing of cervical mucus for LH surge. d. postcoital (Sims-Huhner) test.

Falls just before ovulation and is higher during the last half

At ovulation, the basal body temperature usually: a) Rises abruptly and then falls 1 or 2 days after menstruation starts b) Falls and remains low for the last half of the cycle c) Is higher during the first half of the cycle than in the last half d) Falls just before ovulation and is higher during the last half

Thin and slippery and should stretch to at least 6 cm

Cervical mucus at ovulation should be: a) Thin and slippery and should stretch to at least 6 cm b) Cloudy with a mild odor and should stretch to at least 6 cm c) Thick, clear and of a large quantity d) Thin and tinged with a small amount of blood

Keep the sample near the body, and transport it to the laboratory within 1 hour.

Choose the correct instructions for a man who must provide a semen sample. a. After collecting the sample in a condom, refrigerate it until it is transported to the laboratory. b. Masturbation is the only way a good sample can be obtained. c. Keep the sample near the body, and transport it to the laboratory within 1 hour. d. Do not take any regularly scheduled drugs for 3 days before obtaining the sample.

Condoms should also be used if there is a chance of contracting an STD

Choose the safety teaching related to oral contraceptives. a) Condoms should also be used if there is a chance of contracting an STD b) Nausea and vomiting suggests that stroke may be imminent c) Toxic shock syndrome is more likely when the pill is used d) Increase fluids if urinary frequency or urgency occurs

Weight gain, mittelschmerz, mucus and bloating are assessed

In the symptothermal method of natural family planning a) Intercourse is avoided during the last half of the menstrual cycle b) Weight gain, mittelschmerz, mucus and bloating are assessed c) Intercourse is unsafe if cervical mucus is think and sticky d) Temperature is taken orally every morning and evening

Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly (Misinformation and erroneous beliefs cause adolescents to use ineffective methods of contraception or no method at all. Opportunities to provide counseling and information must not be missed.)

Nurses working with adolescent women should include questions regarding sexuality when gathering data for a reproductive health history. Which of the following principles should guide the nurse when interviewing the adolescent? a. An in-depth exploration of specific sexual practices should be included for this client. b. Sexual histories are optional. c. Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly. d. Questions regarding the client's sexual relationship are unnecessary if she is monogamous.

Contraception should be used until the semen is free of sperm

Post-procedure teaching for a man who has had a vasectomy should include discussion that a) The first one or two urinations may be difficult after the procedure b) A catheterized urine specimen should be obtained in 1 week c) Levels of testosterone may fluctuate for the first few months d) Contraception should be used until the semen is free of sperm

obtain the specimen after a period of abstinence from ejaculation for 2 to 5 days (The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.)

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male client regarding this test, the nurse would tell him to: a. ejaculate into a sterile container. b. obtain the specimen after a period of abstinence from ejaculation for 2 to 5 days. c. transport the specimen with the container packed in ice. d. ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

"Condoms have very few side effects." (Condoms will have local side effects only, such as allergic reaction. They will not produce systemic effects as will the hormone type of contraception. Cost does not alter the effectiveness of a method. Oral hormone contraceptives do not contain other medications. The woman usually makes the final decision about her contraceptive method, and her satisfaction with her choice is crucial.)

The nurse evaluates a client teaching about contraceptives to be effective when the client states: a. "The more the contraceptives cost, the more effective they will be." b. "The birth control pill has a medication in it to prevent most STDs." c. "Condoms have very few side effects." d. "I will use the contraceptive method that my husband prefers."

Spinnbarkheit

Vaginal mucus, when it resembles an egg white in consistency, possesses maximum elasticity and usually precedes or coincides with ovulation. This is known as

Medrocyprogesterone should be given intramuscularly

What should the nurse know about hormone injection? a. Medrocyprogesterone should be given intramuscularly b. the injection site should be massaged vigorously c. injections should be given every 16 weeks d. amenorrhea usually occurs after the first month

explain the purpose for the question asked and how the information will be used (Sufficient time must be spent on gathering relevant data, even if it may be embarrassing for the patient or the nurse or involves intimate topics; always use terms the patient can understand.)

When obtaining a reproductive health history from a female patient the nurse should: a. limit the time spent on exploration of intimate topics. b. avoid asking questions that may embarrass the patient. c. use only accepted medical terminology when referring to body parts and functions. d. explain the purpose for the question asked and how the information will be used.

should be recorded each morning before any activity

When teaching a woman fertility awareness, the nurse should emphasize that the basal body temperature: a. is the average temperature taken each morning. b. should be recorded each morning before any activity c. has a higher degree of accuracy in predicting ovulation than the cervical mucus test. d. can be taken with a mercury thermometer but not a digital one.

sperm swim-up

procedure to capture the sperm most likely to achieve fertilization in a therapeutic insemination

transcervical ballon tuboplasty

procedure to unblock fallopian tubes without using a surgical incision