Infertility Practice Questions (Test #3, Fall 2020)

A nurse working in an infertility clinic should include which of the following in her discussions with the couple? 1. Adoption as an alternative to infertility treatments. 2. The legal controversy surrounding intrauterine insemination. 3. The need to seek marriage counseling before undergoing infertility treatments. 4. Statistics regarding the number of couples who never learn why they are infertile

1 1. It is important for the couple to be provided with all relevant information. Adoption is a viable alternative to infertility treatments. 2. Although there are moral/ethical issues surrounding intrauterine insemination (IUI), there are no legal controversies. Artifi cial insemination is a legal procedure. 3. Although it is not without merit, marriage counseling is not mandatory before seeking infertility treatments. 4. This response is not true. Although up to 10% of couples appear to have no physical cause of their infertility, in the majority of cases a cause is found: one-third of cases are related to female problems, one-third of cases are related to male problems, and one-third of cases are a combination of male and female problems. TEST-TAKING TIP: Whenever clients seek assistance from healthcare professionals, it is the obligation of the professional to provide the clients with all options of care. In the case of infertility, clients should be advised regarding infertility counseling, testing, and interventions as well as adoption strategies. The couple should determine for themselves which route(s) they wish to pursue.

A Roman Catholic couple is infertile. Their healthcare practitioner advises them that their best chance of getting pregnant is via in-vitro fertilization with a mixture of the man's sperm and donor sperm. Which of the following issues, related to this procedure, should the nurse realize may be in conflict with the couple's religious beliefs? Select all that apply. 1. The man will ejaculate by masturbation into a specially designed condom. 2. The woman may become pregnant with donor sperm. 3. Fertilization is occurring in the artificial environment of the laboratory. 4. More embryos may be created than will be used to inseminate the woman. 5. The woman will receive medications to facilitate the ripening of her ova.

1,2,3,4 1. Masturbation and the use of a condom, even for the express purpose of creating life, are considered sins in the Catholic tradition. 2. Procreation with the man's sperm alone is unlikely. The addition of the donor sperm makes this unacceptable in the eyes of the Catholic Church because a woman should become pregnant only by her husband. 3. According to the precepts of the Catholic Church, fertilization may take place only within the body of the woman. 4. It is immoral in the Catholic tradition to create more embryos than are needed to conceive. 5. The medications alone would not be contraindicated per the Catholic Church. The medications are condoned if the ova are being ripened in order for them to become fertilized within her own body. TEST-TAKING TIP: This is an alternateform question. It is critical to heed the notation, "Select all that apply." When discussing reproductive rights and practices, religious imperatives are often important issues to consider.

A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? Select all that apply. 1. Anger at others who have babies. 2. Feelings of failure because they can't make a baby. 3. Sexual excitement because they want so desperately to conceive a baby. 4. Sadness because of the perceived loss of being a parent. 5. Guilt on the part of one partner because he or she is not able to give the other a baby.

1,2,4,5 1. Infertility clients often express anger at others who are able to conceive. 2. Infertility clients often express a feeling of personal failure. 3. Infertility clients often express an aversion to sex because of the many restrictions/ schedules/intrusions that are placed on their sexual relationship. 4. Sadness is another common feeling expressed by infertility clients. 5. Guilt is commonly expressed by infertility clients. TEST-TAKING TIP: Couples who are experiencing infertility express many emotions. One common thread that connects all of the emotions is grief. Infertile couples grieve their inability to conceive. They experience all of the stages of grief including denial, anger, bargaining, and depression. Acceptance, if it is ever reached, often takes many years.

Nurses working in a midwifery office have attended a conference to learn about factors that increase a woman's risk of becoming infertile. To evaluate the nurses' learning, the conference coordinator tests the nurses' knowledge at the conclusion of the seminar. Which of the following problems should the nurses state increase a client's risk of developing infertility problems? Select all that apply. 1. Women who have menstrual cycles that are up to 30 days long. 2. Women who experience pain during intercourse. 3. Women who have had pelvic inflammatory disease. 4. Women who have excess facial hair. 5. Women who have menstrual periods that are over 5 days long.

2,3,4 1. A 30-day menstrual cycle is well within normal limits. 2. Dyspareunia, or pain during intercourse, may be a symptom of a sexually transmitted infection (STI) or of endometriosis. Both STIs and endometriosis can adversely affect a woman's fertility. 3. A woman who has had pelvic infl ammatory disease (PID) is much more likely to have blocked fallopian tubes than a woman who has never had PID. 4. Women who have facial hair (hirsutism) often have polycystic ovarian syndrome (PCOS). PCOS patients frequently have irregular menses, elevated serum cholesterol, and insulin resistance. Women with PCOS are often infertile. 5. A 5-day menstrual period is well within normal limits. TEST-TAKING TIP: Women with PCOS have many symptoms: hirsutism, insulin resistance, high levels of circulating testosterone, and infertility, to name a few. To improve the chances of a woman with PCOS becoming pregnant, she is frequently prescribed Clomid (clomiphene) for the infertility and Glucophage (metformin) for the insulin resistance. Sexually transmitted infections and endometriosis may also impair a woman's fertility

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? 1. The couple has established a set schedule for their sexual encounters. 2. The couple has been married for more than eight years. 3. The couple lives with one set of parents. 4. The couple has close friends who gave birth to a baby within the past year.

1 1. Clients who "schedule" intercourse often complain that their sexual relationship is unsatisfying. 2. Years of marriage are not directly related to a couple's sexual relationship. Clients may have a very healthy relationship after many years of marriage. 3. The fact that the couple lives with one set of parents is unlikely related to their sexual relationship. 4. Although it can be very difficult to be around couples who have become pregnant and/or have healthy babies, this factor is not usually related to a couple's sexual relationship. TEST-TAKING TIP: When answering questions about the nursing process, it is important for the test taker to make sure that each diagnosis is independent. For example, when the nurse identifi es sexual dysfunction related to decreased libido as a diagnosis, then the assessments, as well as the goals, interventions, and evaluations, must relate directly to that problem

An infertile woman has been diagnosed with endometriosis. She asks the nurse why that diagnosis has made her infertile. Which of the following explanations is appropriate for the nurse to make? 1. "Scarring surrounds the ends of your tubes, preventing your eggs from being fertilized by your partner's sperm." 2. "You are producing insufficient quantities of follicle-stimulating hormone that is needed to mature an egg every month." 3. "Inside your uterus is a benign tumor that makes it impossible for the fertilized egg to implant." 4. "You have a chronic infection of the vaginal tract that makes the secretions hostile to your partner's sperm."

1 1. Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The tissue may be on, for example, the tubes, ovaries, or colon. Adhesions develop from the monthly bleeding at the site of the misplaced endometrial tissue, often resulting in infertility. 2. Endometriosis is not characterized by hormonal imbalances. Hormonal imbalances can, however, lead to infertility. 3. A benign tumor of the muscle of the uterus is called a fibroid. It can interfere with pregnancy, but it is not related to endometriosis. 4. Endometriosis is not caused by an infection. TEST-TAKING TIP: This question is essentially a knowledge-level question. All of the answer options relate to infertility problems, but only one is specifically related to endometriosis. It is important to have an understanding of gynecological issues since many do affect a woman's fertility.

The nurse is providing counseling to a group of sexually active single women. Most of the women have expressed a desire to have children in the future but not within the next few years. Which of the following actions should the nurse suggest the women take to protect their fertility for the future? Select all that apply. 1. Use condoms during intercourse. 2. Refrain from smoking cigarettes. 3. Maintain an appropriate weight for height. 4. Exercise in moderation. 5. Refrain from drinking carbonated beverages.

1,2,3,4 1. Condoms should be worn during sexual contacts to prevent infection with a sexually transmitted disease, which can affect the long-term health of the woman's reproductive system. 2. Women who smoke have a higher incidence of infertility than those who do not smoke. (See http://asrm.org/search/ detail.aspx?id=2356&q=smoking) 3. Women who are either overweight or underweight have increased incidence of infertility. 4. Body mass index (BMI) is related to the amount of exercise a woman engages in. Those who exercise excessively are more likely to have a very low BMI and those who rarely exercise, to be obese. Since fertility is related to body weight, it is recommended that women exercise in moderation. 5. There is some evidence that caffeine in large quantities may affect fertility, but decaffeinated carbonated beverages have never been cited as affecting one's fertility. TEST-TAKING TIP: There are a number of factors that can affect fertility. Some of the factors are beyond a woman's control. For example, a woman may not marry until she is in her 30s and, consequently, may delay conception. Other factors, such as smoking cigarettes and exercising, are controllable

A couple is seeking infertility counseling. The practitioner has identified the factors listed below in the woman's health history. Which of these findings may be contributing to the couple's infertility? 1. The client is 36 years old. 2. The client was 13 years old when she started to menstruate. 3. The client works as a dental hygienist 3 days a week. 4. The client jogs 2 miles every day.

1. The eggs of an older woman (for reproductive purposes considered age 35 years +) age and fertility is reduced. 2. Age 13 at the time of menarche is not a significant factor. 3. Working as a dental hygienist has not been shown to affect fertility. 4. Excessive exercise can interrupt hormonal function, but jogging 2 miles a day is a moderate exercise pattern. TEST-TAKING TIP: The woman was 13 years old at menarche, an age that is well within normal limits. Working as a dental hygienist has not been shown to increase one's chances of developing infertility. An excessive exercise schedule is a problem, but jogging 2 miles a day is well within the definition of moderate exercise. When women are over 35 years of age, however, their fertility often drops.

A client is receiving Pergonal (menotropins) intramuscularly for ovarian stimulation. Which of the following is a common side effect of this therapy? 1. Piercing rectal pain. 2. Mood swings. 3. Visual disturbances. 4. Jerky tremors.

2 1. Piercing rectal pain has not been cited as a side effect of Pergonal. 2. Mood swings and depression are common side effects of the hormonal therapy. 3. Visual disturbances have not been cited as a side effect of Pergonal. 4. Jerky tremors have not been cited as a side effect of Pergonal. TEST-TAKING TIP: Not only is infertility itself a psychological stressor but the therapy used to treat it is also a stressor. The client is given daily injections of Pergonal (a mixture of FSH and LH) for 10 days to 2 weeks. The impact of the hormonal injections can be very disruptive to the woman's psyche, leading to mood swings and, in some cases, severe depression.

Which instruction by the nurse should be included in the teaching plan for an infertile woman who has been shown to have a 28-day biphasic menstrual cycle? 1. Douche with a cider vinegar solution immediately before having intercourse. 2. Schedule intercourse every day from day 8 to day 14 of the menstrual cycle. 3. Be placed on follicle-stimulating hormone therapy by the fertility specialist. 4. Assess the basal body temperature pattern for at least 6 more months.

2 1. Unless medically indicated, douching should never be performed. A vinegar solution is especially inappropriate since sperm are unable to survive in an acidic environment. 2. This action is recommended. Pregnancy is most likely to occur with daily intercourse from 6 days before ovulation up to the day of ovulation. 3. If a client is experiencing a biphasic cycle, FSH therapy is probably not indicated. 4. The BBT chart does not need to be monitored for 6 more months, although it can be used to help time intercourse. TEST-TAKING TIP: A biphasic cycle on a BBT chart is evidenced by a relatively stable temperature at the beginning of the cycle, a slight dip in temperature at the time of ovulation, and a sustained rise in temperature—of at least 0.4°F for the remainder of the cycle.

Infertility increases a client's risk of which of the following diseases? 1. Diabetes mellitus. 2. Nystagmus. 3. Cholecystitis. 4. Ovarian cancer.

4 1. Diabetes has been shown to affect a woman's fertility, but infertility has not been shown to increase a woman's risk of developing diabetes. 2. Infertility has not been shown to increase a woman's risk of developing nystagmus. 3. Infertility has not been shown to increase a woman's risk of developing cholecystitis. 4. Infertility has been shown to increase a woman's risk of developing ovarian cancer. TEST-TAKING TIP: For a number of years, an association was noted between the long-term use of Clomid (clomiphene) to treat infertility and the incidence of ovarian cancer. It has also been shown that infertility itself is a contributing factor for ovarian cancer. The reason for the association is not yet known

A client is to have a hysterosalpingogram. Which of the following information should the nurse provide to the client prior to the procedure? 1. "The test will be performed through a small incision next to your belly button." 2. "You will be on bedrest for a full day following the procedure." 3. "An antibiotic fluid will be instilled through a tube in your cervix." 4. "You will be asked to move from side to side so that x-ray pictures can be taken."

4 1. No incision is created when clients have hysterosalpingograms. 2. The client will be able to ambulate normally after the procedure. 3. A dye is instilled into the uterine cavity. Some doctors do prescribe oral antibiotics following the procedure to prevent infection. 4. This statement is correct. A number of pictures will be taken throughout the procedure. The client, who will be awake, is asked to move into positions for the x-rays. TEST-TAKING TIP: A hysterosalpingogram is one of the many tests performed during a standard infertility work-up. The test taker should be familiar with the rationale for each of the tests as well as the procedures themselves and the information that should be conveyed to each client who is to undergo one of the procedures

An infertility specialist is evaluating whether a woman's cervical mucus contains enough estrogen to support sperm motility. Which of the following tests is the physician conducting? 1. Ferning capacity. 2. Basal body temperature. 3. Colposcopy. 4. Hysterotomy.

1 1. When a woman's cervical mucus is estrogen rich, it is slippery and elastic (thread-like), and when assessed under a microscope, the practitioner will observe "ferning"—that is, an image that looks like a fern. The woman is then in her fertile period. When she is not in her fertile period, the mucus is thick and gluey. 2. Basal body temperature assessments are performed to determine if and when ovulation occurs. 3. Colposcopy is a procedure performed to examine the cervix closely. It is not performed to evaluate the receptivity of a woman's cervical mucus to sperm. 4. A hysterotomy is a procedure in which an incision is made into the uterus. TEST-TAKING TIP: When estrogen levels are high, a woman's cervical mucus is most receptive to a man's sperm. At that time, the pH of the vaginal and cervical environments is most conducive to the sperm's successful migration into the uterus and into the fallopian tubes.

A client is to receive Pergonal (menotropins) injections for infertility prior to in-vitro fertilization. Which of the following is the expected action of this medication? 1. Prolongation of the luteal phase. 2. Stimulation of ovulation. 3. Suppression of menstruation. 4. Promotion of cervical mucus production.

2 1. The luteal phase occurs after ovulation. Pergonal is given to induce ovulation. 2. Pergonal is administered to infertile women to increase follicular growth and maturation of the follicles and to stimulate ovulation. 3. Pergonal does not suppress menstruation or promote cervical mucus production. 4. Pergonal does not suppress menstruation or promote cervical mucus production. TEST-TAKING TIP: It is possible that the test taker would not know the action of Pergonal. When the generic name is seen, however, an educated guess can be made. A "tropin" is a substance that stimulates an organ to do something. The only answer that states that an organ is being stimulated is choice 2.

A nurse is educating a client who has been diagnosed with infertility on how to complete a basal body temperature chart to determine her ovulation pattern. The client states, "I really don't want to take my temperature every day. Is there any other way to find out if and when I ovulate?" 1. "There are a number of other ways to determine ovulation, but they all require you to be examined by an obstetrician every month." 2. "A test you can do at home requires you to spit on a microscopic slide and then look at the slide under a microscope." 3. "You can test your vaginal discharge each day to determine when you should have intercourse because the hormone progesterone is elevated. " 4. "Although there are some tests that you can perform at home, they all cost well over a hundred dollars to purchase."

2 1. This response is incorrect. There are a number of ovulation predictor tests that women can use at home to determine when they are ovulating. 2. This statement is correct. One of the at-home ovulation predictor kits requires women to place saliva on a microscopic slide and, after allowing the saliva to dry, to look at the slide under a microscope. If ovulation is occurring, the saliva appears ferned, that is, the image on the slide looks like the leaflets of a fern. The test detects the presence of high levels of estrogen in the woman's saliva. 3. Although the vaginal discharge does change during women's menstrual cycles, there are no ovulation detection tests that require women to test their vaginal discharge. 4. Some of the ovulation detection kits are very expensive, while others require a minimal expense. The women may have to test their saliva and urine repeatedly over the course of many days or months, however, requiring them to purchase multiple test kits. TEST-TAKING TIP: Women who wish to determine the timing of ovulation in order to maximize their potential of having intercourse at their most fertile period have many options available to them. They can monitor their BBT over a number of months to determine their pattern of ovulation. They can also employ a number of ovulation predictor tests that can be purchased without prescription. Some of the tests require women to test their urine, which will indicate when they are experiencing their LH surge, while others require women to test their saliva for high levels of estrogen.

A female client seeks care at an infertility clinic. Which of the following tests may the client undergo to determine what, if any, infertility problem she may have? Select all that apply. 1. Chorionic villus sampling. 2. Endometrial biopsy. 3. Hysterosalpingogram. 4. Serum progesterone assay. 5. Postcoital test.

2,3,4,5 1. Chorionic villus sampling is done to assess for genetic disease in the fetus. 2. Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. 3. Hysterosalpingogram is performed after menstruation to detect whether or not the fallopian tubes are patent. 4. Serum progesterone assay is performed about 1 week following ovulation to determine whether or not the woman's corpus luteum produces enough progesterone to sustain a pregnancy. 5. Postcoital tests are performed about 1 to 2 days before ovulation to determine whether healthy sperm are able to survive in the cervical mucus TEST-TAKING TIP: There are a number of tests that are performed to assess fertility in couples. It is important to remember that many of the assessments are invasive, painful, and embarrassing and, depending on the results, may label one of the partners as the cause of the infertility. The knowledge of who is responsible for the infertility can be very diffi cult for some clients to learn.

A client who is undergoing ovarian stimulation for infertility calls the infertility nurse and states, "My abdomen feels very bloated, my clothes are very tight, and my urine is very dark." Which of the following is the appropriate statement for the nurse to make at this time? 1. "Please take a urine sample to the lab so they can check it for an infection." 2. "Those changes indicate that you are likely already pregnant." 3. "It is important for you to come into the office to be examined today." 4. "Abdominal bloating is an expected response to the medications."

3 1. It is unlikely that this woman has a urinary tract infection. 2. It is unlikely that the client is already pregnant. 3. This client should be seen by her infertility doctor. 4. Abdominal bloating is a sign of ovarian hyperstimulation. TEST-TAKING TIP: This client is exhibiting signs of ovarian hyperstimulation. This is a serious complication. The client is likely third spacing her fl uids (the fl uids in her body are shifting into her interstitial spaces), resulting in abdominal distention, oliguria, and concentrated urine. The client should be evaluated by her physician.

A couple has been told that the male partner, who is healthy, is producing no sperm "because he has cystic fibrosis." Which of the following explanations is accurate in relation to this statement? 1. Since the man is healthy, he could not possibly have cystic fibrosis. 2. Men with cystic fibrosis often have no epididymis. 3. The expressivity of cystic fibrosis is variable. 4. Cystic fibrosis is a respiratory illness having nothing to do with reproduction.

3 1. The man may have both recessive genes for cystic fibrosis even though he is not ill. 2. This answer is incorrect. Some men with cystic fibrosis, however, have no vas deferens. 3. This statement is correct. Cystic fibrosis can be expressed in a number of ways. Some affected individuals have very serious illness resulting in early death, while others experience few symptoms. 4. This statement is incorrect. Some males with cystic fibrosis have no vas deferens and, even if the vas is present, if the man is producing large amounts of thick mucus, the vas may become obstructed. Similarly, in women, the fallopian tubes may become obstructed with thick mucus. TEST-TAKING TIP: Infertility and genetics are often related. In this situation, the genetic disease cystic fi brosis has resulted in aspermia. In addition, many miscarriages are caused by inborn genetic defects. In general, clients who are infertile should be referred for genetic counseling.

A couple is seeking infertility counseling. During the history, it is noted that the man is a cancer survivor, drinks one beer every night with dinner, and takes a sauna every day after work. The response provided by the nurse should be based on which of the following? 1. It is unlikely that any of these factors is affecting his fertility. 2. Daily alcohol consumption could be altering his sperm count. 3. Sperm may be malformed when exposed to the heat of the sauna. 4. Cancer survivors have the same fertility rates as healthy males.

3 1. This response is incorrect because exposing the testes to the heat of the sauna can alter the normal morphology of the sperm. 2. Alcohol consumed in excessive amounts can alter spermatogenesis, but one beer per day has not been shown to be a problem. 3. The high temperature of the sauna could alter the number and morphology of the sperm. 4. Chemotherapy has been shown to affect the ability of males to create sperm. TEST-TAKING TIP: The test taker should try not to be fooled by quantities and numbers when they are included in the stem or answer options. The stem states that the male consumes one beer each evening. That quantity has not been shown to affect fertility.

A couple is seeking advice regarding actions that they can take to increase their potential of becoming pregnant. Which of the following recommendations should the nurse give to the couple? 1. The couple should use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The man should be on top during intercourse.

3 1. Use of vaginal lubricants is not recommended. Vaginal lubricants may alter the pH of the reproductive system, adversely affecting the couple's potential of becoming pregnant. 2. Delaying intercourse until the day of ovulation is a poor recommendation. The sperm live for about 3 days. If the couple has daily intercourse beginning 5 or 6 days before ovulation (the "fertile window") and continuing until the day of ovulation, they will maximize their potential of becoming pregnant. 3. The woman should refrain from douching. Douching can change the normal flora and the pH in the vagina, making the environment hostile to the sperm. 4. The position of the couple during intercourse will not affect the potential fertility of the woman. TEST-TAKING TIP: There is a great deal of false information in the community regarding ways to maximize one's ability to become pregnant. For example, some couples believe that they should have intercourse less frequently when trying to become pregnant because sperm potency drops with frequent ejaculations. This notion has not been shown to be true. Clients need fact-based information regarding ways to maximize their ability to conceive.

An Orthodox Jewish couple is seeking infertility counseling. The woman states that her menstrual cycle is 21 days long. After testing, no physical explanation is found for the infertility. Which of the following may explain why the woman has been unable to conceive? 1. Her kosher diet is lacking the essential nutrients needed for achieving optimal reproductive health. 2. The positions allowed Orthodox Jewish couples during intercourse hinder the process of fertilization. 3. Orthodox Jewish couples are known to have a high rate of infertility because of inborn genetic diseases. 4. Orthodox Jewish couples refrain from intercourse during menses and for seven days after it ends.

4 1. Kosher diets are complete, providing all nutrients, vitamins, and minerals needed by the body. 2. There are no specific positions mandated by Jewish law that inhibit fertilization. 3. Although Jews do exhibit a large number of genetic diseases, they are not prone to infertility in higher numbers than the general population. 4. Jewish law does prohibit intercourse during the menses and for 7 days following menses. The woman then goes through a cleansing bath called a mikvah before she and her husband may have intercourse. With such a short cycle, she is ovulating during the time frame in which intercourse is restricted. TEST-TAKING TIP: Remember to consider cultural differences when making nursing assessments and considering nursing interventions. There are three main Jewish traditions: Orthodox, Conservative, and Reform. Orthodox Jews strictly adhere to the Laws set forth in the Torah, the first five books of the old testament of the Bible. Conservative Jews are observant but less restrictive in their beliefs, while Reform Jews are the most liberal in their traditions. When asked about Jewish traditions, it is important for the test taker to be aware of which group of Jews is being discussed.

A client is to have a hysterosalpingogram. In this procedure, the physician will be able to determine which of the following? 1. Whether or not the ovaries are maturing properly. 2. If the endometrium is fully vascularized. 3. If the cervix is incompetent. 4. Whether or not the fallopian tubes are obstructed

4 1. Only the uterus and the fallopian tubes are evaluated during a hysterosalpingogram. 2. Tumors and other gross assessments of the uterus can be made out, but the vascularization of the endometrium is beyond the scope of the test. 3. The competency of the cervix cannot be evaluated during a hysterosalpingogram. 4. The primary goal of a hysterosalpingogram is to learn whether or not the fallopian tubes are patent. TEST-TAKING TIP: During a hysterosalpingogram, a dye is inserted through the vagina into the uterine cavity. The dye, visualized on x-ray, then travels up into the fallopian tubes. If the tubes are blocked owing to scarring or endometriosis, the dye does not ascend.

A 35-year-old client is being seen for her yearly gynecological examination. She states that she and her partner have been trying to become pregnant for a little over 6 months and that a friend had recently advised her partner to take ginseng to improve the potency of his sperm. The woman states that they have decided to take their friend's advice. On which of the following information should the nurse base his or her reply? 1. Based on their history, the client and her partner have made the appropriate decision regarding their fertility. 2. Ginseng can cause permanent chromosomal mutations and should be stopped immediately. 3. It is unnecessary to become concerned about this woman's fertility because she has tried to become pregnant for only a few months. 4. Although ginseng may be helpful, it would be prudent to encourage the woman to seek fertility counseling.

4 1. On the Web, there are sites that promote the intake of ginseng as a therapy for both male and female infertility, although there is no strong evidence to show that either is true. In addition, there is nothing in the question to suggest that the infertility problem is caused by the poor quality of the man's sperm. 2. There is no evidence that ginseng causes mutations; rather, there is some evidence to show that it is antimutagenic. 3. There is cause for concern for this woman because she is 35 years old and has been unable to get pregnant for more than 6 months. 4. Because fertility drops as a woman ages, it is advisable to encourage the couple to use conventional therapies in conjunction with the complementary therapy to maximize their potential of becoming pregnant. TEST-TAKING TIP: Complementary therapies are becoming more and more popular among clients. Although many have not been shown to have direct effects, it can be counterproductive to discourage clients from using complementary therapies. This may alienate the clients from the healthcare provider. Unless they are known to be dangerous, it is much better to encourage clients to combine standard and complementary methods rather than to dissuade clients from using them