Maternal-Newborn Ch 29 contraception and unplanned pregnancies

A nurse is providing education to a client with infertility concerns. Which statement by the client indicates appropriate understanding of the Spinnbarkeit Test? "I will need to purchase a microscope and look for a fern-like pattern from a sample of my cervical mucus to indicate when I am ovulating." "I will need to purchase an over-the-counter ovulation kit that will tell me when I am currently ovulating." "Halfway in my cycle I will need to check my cervical mucus to see if I can stretch it in to long strands, indicating I am close to ovulating." "At midpoint in my menstrual cycle, I need to come to the clinic for a cervical exam looking for color changes to my cervical mucus."

"Halfway in my cycle I will need to check my cervical mucus to see if I can stretch it in to long strands, indicating I am close to ovulating."

The nurse instructs a patient on the use of a vaginal estrogen/progestin rings (NuvaRing) for contraception. Which patient statement indicates that additional instruction is needed? "I am to take the ring out overnight." "I will leave the ring in place for 3 weeks." "I leave the ring in place during intercourse." "I am to use other birth control if I take the ring out for 4 hours."

"I am to take the ring out overnight."

A couple comes to the clinic for a fertility evaluation. The male partner is to undergo a semen analysis. After teaching the partner about this test, which client statement indicates that the client has understood the instructions? "I need to bring the specimen to the lab the day after collecting it." "I will place the specimen in a special plastic bag to transport it." "I have to abstain from sexual activity for about 2 to 5 days before the sample." "I will withdraw before I ejaculate during sex to collect the specimen."

"I have to abstain from sexual activity for about 2 to 5 days before the sample."

After teaching a woman who has chosen the vaginal ring as her method of contraception, the nurse determines that the client needs additional teaching when she makes which statement? "It must be centered on my cervix to be effective ." "I'll compress the ring, inserting it as far back as possible." "I will insert a new ring at the same time and day of every week." "Once I remove the ring, I'll discard it."

"I will insert a new ring at the same time and day of every week."

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 subfertility problem, it is the man who is subfertile."

A woman is going to have in vitro fertilization. When preparing her for this, the nurse would make which statement? "It can be done with frozen donor sperm." "You will need to select a surrogate mother." "Most procedures are effective the first time tried." "This is dangerous if there is ovarian cancer in your family."

"It can be done with frozen donor sperm."

A female client comes to the clinic and asks the nurse what would be the most cost effective method for her to determine her ovulation patterns. What is the best response by the nurse? "The least costly method to determine ovulation patterns is to record the basal body temperature for at least 4 months." "The least costly method would be a surgical procedure to determine if your fallopian tubes are blocked." "The least costly method would be to purchase a commercial kit from the store to assess the upsurge of LH that occurs just after ovulation." "The least costly method would be to purchase an at-home testing kit for sperm motility."

"The least costly method to determine ovulation patterns is to record the basal body temperature for at least 4 months."

A nursing instructor is teaching about subfertility to nursing students and perceives their understanding when they define subfertility existing when a pregnancy has not occurred after how much time of engaging in unprotected coitus? 6 months 12 months 9 months 18 months

12 months

A nurse is assessing a man who, along with his partner, has been having trouble conceiving. When assessing the man, which area would the nurse most likely include as possibly affecting his fertility? A 24-hour food intake History of a sexually transmitted disease Testes exposed to radiation A job that requires sitting all day History of a fractured bone History of mental illness

A 24-hour food intake History of a sexually transmitted disease Testes exposed to radiation A job that requires sitting all day

A 40-year-old woman who smokes desires a reliable contraceptive method. Which should the nurse recommend to this patient? An ovulation suppressant A condom and spermicide A spermicidal suppository The rhythm (calendar) method

A condom and spermicide

After assessing a client, a nurse determines that an IUD as a method of contraceptive would be contraindicated based on a history of which finding? Smoking Hypertension Abnormal uterine shape Thromboembolic disease

Abnormal uterine shape

A nurse is teaching a client about the various contraceptives on the market. Which of the following is a 100% effective method of birth control and protection against sexually transmitted infections (STIs)? Depo-Provera Oral contraceptives Rhythm method Abstinence

Abstinence

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.

Begin a new activity together.

A client asks the nurse, "What would be the best way to get pregnant." The nurse would incorporate which of the following in the response? Conception is more likely in the presence of orgasm Conception is more likely if the sperm has just been ejaculated The timing of intercourse and conception affects the sex of the pregnancy Conception is more likely when intercourse occurs within 72 hours of ovulation

Conception is more likely when intercourse occurs within 72 hours of ovulation

A patient who has unprotected intercourse has obtained the morning after pill but has not yet taken the prescribed dosage. What nursing diagnosis should the nurse identify as appropriate for the patient at this time? Powerlessness Spiritual distress Decisional conflict Readiness for enhanced knowledge

Decisional conflict

What advice can the nurse give a female patient trying to conceive to facilitate sperm collection to the cervix? Elevate the hips on a small pillow after coitus. Douche immediately after coitus to push the sperm through the cervix. Use the side-lying position for intercourse. Remain on the back for at least 3 minutes after intercourse.

Elevate the hips on a small pillow after coitus.

The nurse is discussing permanent birth control with a female patient and her husband. Which of the following is considered a permanent nonsurgical sterilization method? Tubal ligation Tubal occlusion Vasectomy Essure

Essure

The female partner of a young couple is concerned about what the results of fertility tests might reveal. Which nursing diagnosis should the nurse use to plan care for this patient? Fear related to possible outcome of subfertility studies Deficient knowledge related to measures to promote fertility Anxiety related to the procedures necessary for fertility testing Situational low self-esteem related to the apparent inability to conceive

Fear related to possible outcome of subfertility studies

When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply. General health Medication history Sexual history Surgical history School history

General health Medication history Sexual history Surgical history

A patient comes into the family planning clinic and requests a prescription for birth control pills. Which assessment finding indicates that an ovulation suppressant would not be the best contraceptive method for the patient? Age 30 years Allergy to foreign protein Irregular menstrual cycles History of thromboembolism

History of thromboembolism

The nurse is explaining the various evaluations used to determine infertility to a young couple who have been trying to get pregnant for 5 years. Which instruction should the nurse prioritize when teaching about the postcoital test? Should douche before the test Can be combined with a sperm count Is performed close to time of ovulation Will use a prescribed lubricant during vaginal intercourse

Is performed close to time of ovulation

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 woman visits the family planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her? She is 30 years old. She has irregular menstrual cycles. She has a history of allergy to foreign protein. She has a family history of thromboembolism.

She has a family history of thromboembolism.

Which information is important for a woman to understand before undergoing a scheduled tubal ligation? She will have lessened dysmenorrhea following the procedure. She must think of the procedure as irreversible. The procedure will reduce her menstrual flow in amount. She should schedule it to be done just before a menstrual flow.

She must think of the procedure as irreversible.

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 woman telephones the nurse after taking an ovulation suppressant for 3 months to state that she has forgotten to take her pill two mornings in a row. What would be the best advice to give her regarding this? Start a new cycle of 21 pills immediately plus additional estrogen for the next 3 days. Take three pills immediately and avoid coitus for the remainder of the month. Take two pills now and use a second method of contraception for the remainder of the month. Take two pills a day for the rest of the month.

Take two pills now and use a second method of contraception for the remainder of the month.

A client is seen in the clinic requesting an emergency postcoital contraception pill levonorgestrel. The client states that she had unprotected sex 3 ½ days ago. What is the most appropriate response by the nurse? "The pill will cause you to begin menstruating within a day." "Unfortunately you are past the time frame to take that prescription." "You should contact the local abortion clinic to set up an appointment." "You will need to also be treated with antibiotics for an ST"

Unfortunately you are past the time frame to take that prescription."

The nurse at a fertility clinic determines the risk factors for clients using oral contraceptives. Which client would be at highest risk for heart attack or stroke related to use of these contraceptives? a 15-year-old with a previous miscarriage a 22-year-old woman who drinks alcohol a 38-year-old woman who smokes a 32-year-old woman who has asthma

a 38-year-old woman who smokes

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation? an ovulation suppressant a spermicidal suppository the rhythm (calendar) method a diaphragm and spermicide

a diaphragm and spermicide

A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence? cervical infection a weight gain of 10 lb (4.5 kg) a vaginal infection six months of nonuse

a weight gain of 10 lb (4.5 kg)

A nurse is counseling women on birth control choices. Which woman is the best candidate for an IUD? a woman who has multiple sex partners a woman who has a history of PID a woman who is in her early twenties and wants children later in life a woman who has one partner and three children

a woman who has one partner and three children

A client prescribed COC has presented for a routine visit. Which finding upon assessment should the nurse prioritize? abdominal pain small amount of breakthrough bleeding light menstrual flow cramping during menses

abdominal pain

A woman comes to the clinic because she has been unable to conceive. When reviewing the woman's history, the nurse would least likely identify which factor as a possible risk? age of 25 years history of smoking diabetes since age 15 years weight below standard for height and age

age of 25 years

A woman comes to the clinic because she has been unable to conceive. When reviewing the woman's history, the nurse would least likely identify which factor as a possible risk? age of 25 years history of smoking diabetes since age 15 years weight below standard for height and age

age of 25 years

The nurse is teaching a young couple, who desire to start their family, the various methods for determining fertility. After discovering the woman regularly travels internationally for work, deals with a lot of job anxiety and frequently uses an electric blanket at home, the nurse will discourage the use of which method? calendar method basal body temperature method cervical mucus method symptothermal method

basal body temperature method

A nurse is teaching a couple about how to use a condom. The nurse determines the couple can properly apply the condom when they state that it should be applied at which time to be most effective? as part of foreplay at least 1 hour prior to coitus before penile-vulvar contact immediately after ejaculation

before penile-vulvar contact

A woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by: dilating the cervix. acting as a toxin to the trophoblastic tissue. blocking the action of progesterone on the endometrium. causing uterine contractions to expel the uterine contents.

causing uterine contractions to expel the uterine contents.

The nurse discusses various contraceptive methods with a client and her partner. After the discussion, the nurse determines that the couple understood the information when they identify which method as being available only with a prescription? cervical cap cervical sponge condom spermicide

cervical cap

A healthy 28-year-old female client who has a sedentary lifestyle and is a chain smoker is seeking information about contraception. The nurse informs this client of the various options available and the benefits and the risks of each. Which should the nurse recognize as contraindicated in the case of this client? the medroxyprogesterone injection combination oral contraceptives a copper intrauterine device implantable contraceptives

combination oral contraceptives

The nurse is meeting with a 36-year-old client who wishes to begin using contraceptives. The client reports being in a long-term, monogamous relationship, runs 2 miles per day, and smokes a pack of cigarettes each day. Which method will the nurse be least likely to suggest to the client? combination oral contraceptives condoms coitus interruptus spermicides

combination oral contraceptives

A client reports that she has multiple sex partners and has a lengthy history of various pelvic infections. She would like to know if there is any temporary contraceptive method that would suit her condition. Which method should the nurse suggest for this client? intrauterine device (IUD) condoms oral contraceptives (OCs) tubal ligation

condoms

Which of the following would NOT be considered a disadvantage of the calendar/rhythm method of family planning? Cost Effectiveness Need for motivation Need for cooperation

cost

The nurse should carefully screen a client who insists on using only combined oral contraceptives for which contraindication? deep vein thrombosis gastrointestinal disease impaired absorption use of alcohol

deep vein thrombosis

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only by prescription? condom spermicide diaphragm basal body temperature

diaphragm

A woman in the 15th week of gestation is planning on terminating the pregnancy. The procedure done for second trimester terminations is which of the following? menstrual extraction dilatation and curettage dilatation and extraction hysterotomy

dilatation and extraction

The nurse is providing contraception counseling to a perimenopausal woman who has had negative reactions to oral contraceptives in the past and would like a long-term, nonhormone-based method that has a high rate of success. Neither she nor her husband wants to undergo surgery, however. Which method should the nurse recommend? intrauterine device transdermal patch subdermal progestin implant tubal ligation

intrauterine device

A woman is using depot medroxyprogesterone acetate (Depo-Provera) as a method of birth control. Which side effect would the nurse most likely include as common? constipation nausea irregular menstruation pregnancy

irregular menstruation

The nurse informs the client that a diaphragm is an example of which type of contraception? chemical barrier mechanical barrier transdermal intrauterine

mechanical barrier

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 2 to 5 mL of semen ejaculated sperm density about 20 million/mL morphology of sperm within normal limits

no or few sperm cells produced

A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which event? onset of menses ovulation pregnancy safe period for intercourse

ovulation

A woman and her partner have been trying to conceive for over 2 years without success. Ultrasound imaging reveals scarring of her fallopian tubes, which appears to be the primary cause of subfertility. What is the most likely cause of the scarring? pelvic inflammatory disease ruptured appendix abdominal surgery Turner syndrome

pelvic inflammatory disease

Which description best explains the hysterosalpingogram procedure? insertion of an endoscope through the posterior fornix to visualize the reproductive organs instillation of carbon dioxide through the cervix into the uterus and fallopian tubes passage of an endoscope through a small abdominal incision to inspect the reproductive organs radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix

radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix

A perimenopausal woman asks for help in selecting a contraceptive. She reports vaginal dryness during intercourse and says that her partner does not like the feel of condoms. Which method should the nurse recommend? spermicide female condom cervical cap diaphragm

spermicide

The estrogen content in the contraceptive pill performs which action? decreases the permeability of cervical mucus increases the level of luteinizing hormone (LH) interferes with endometrial proliferation suppresses follicle-stimulating hormone (FSH)

suppresses follicle-stimulating hormone (FSH)

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

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus? when it is thin, watery, and copious when it is thick Cervical mucus is not a reliable indicator. when it does not stretch

when it is thin, watery, and copious

The nurse is meeting with a young couple who have undergone the initial screenings for infertility. The man is questioning the possibility of using artificial insemination if he is found to be infertile. Which response should the nurse prioritize? "Artificial insemination is a possibility but there is the increased chance of twins." "Artificial insemination is useful only if your sexual partner has an allergy to your sperm, not if you are infertile." "Artificial insemination is your best option if you are found to be infertile." "You and your sexual partner should consider embryo transfer first because it is safer."

"Artificial insemination is your best option if you are found to be infertile."

A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide? "Replace the diaphragm every 6 months." "Have your diaphragm refitted if you lose 10 pounds (4.5 kilograms) or more." "Keep the diaphragm in place for no more than 4 hours after intercourse." "Wet the diaphragm with water first before inserting it."

"Have your diaphragm refitted if you lose 10 pounds (4.5 kilograms) or more."

The nurse working in a free health clinic assess a 17-year-old client interested in contraceptives. Which statement, if said by the client, would indicate that female or male condoms would be the appropriate recommendation for this client? "I have no problems swallowing medications." "Last year I was diagnosed with HPV." "I am leaving for college in just a few months." "I do not want to follow in my sister's footsteps."

"Last year I was diagnosed with HPV."

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."

The nurse has completed a fertility assessment on a couple and is preparing outcomes for care. Which statement indicates that the couple wants to continue with the process, regardless of the outcome? Couple interested in learning about other options to having a family. Couple wants to have a family but has limited resources for artificial methods. Couple states the desire to minimize disruptions in their normal activities for testing. Couple desires to continue with testing after it is determined that one partner is fertile.

Couple desires to continue with testing after it is determined that one partner is fertile.

What is an advantage of a cervical cap over a diaphragm? No initial fitting is required. It can be left in place longer. It needs no spermicidal jelly. It does not need to be refitted after pregnancy.

It can be left in place longer.

A patient received a scheduled dose of depot medroxyprogesterone acetate (DMPA) 6 weeks ago. Today, the patient reports that a regular menstrual cycle is 2 weeks late. What is the first thing that should be done for this patient? Perform a pregnancy test. Provide prenatal counseling. Discuss pregnancy termination options. Explain side effects of the contraceptive.

Perform a pregnancy test.

A nurse is preparing a presentation for a health fair on the topic of vasectomy. Which information should the nurse point out in the information? Relatively easy procedure with few complications Regular sperm counts are not essential Procedure is effective immediately Birth control measures are not required

Relatively easy procedure with few complications

A nurse supervisor observes a nurse massage a client's injection site after giving a dose of depot medroxyprogesterone acetate. What is the priority response by the nurse supervisor? Remind the nurse that this injection should absorb slowly. Thank the nurse for excellent client care. Write up an incident report for the medication error. Call the health care provider immediately.

Remind the nurse that this injection should absorb slowly.

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.

The nurse is planning an educational session on contraceptives for a group of adolescent high school students. What does the nurse need to do when planning this session? Argue that encouraging abstinence is unrealistic during the teenage years. Discuss that the application of a condom should occur after penile-vulvar contact. Explain that the combination oral contraceptive approach is the best for adolescents. Teaching about contraceptive options while avoiding indirect encouragement of sexual activity.

Teaching about contraceptive options while avoiding indirect encouragement of sexual activity.

The nurse in a primary care clinic and a client have come to see the primary care provider because the client is getting married and wants to have a prenuptial gynecologic examination. After the exam, the nurse asks about the woman's plan to have a family. The woman responds, "Why do I have to plan for a family?" What would be the nurses's best response? Families are always best when pregnancies are not planned. The couple can control the time between births when they plan their family. An unwanted pregnancy can always be aborted. The couple can decide on a method of birth control.

The couple can control the time between births when they plan their family.

The nurse is conducting a well-visit physical assessment on a 29-year-old female. The nurse determines the client is probably ovulating based on which condition of the cervical mucus? Thin, slippery, and stretchy Cloudy, thick, and watery Clear and of large quantity Thin and red-tinged

Thin, slippery, and stretchy

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will: increase a degree. decrease a degree. fluctuate a degree daily. no longer reflect basal body temperature.

increase a degree.

The client is interested in using an injectable contraceptive that works by suppressing pituitary secretions. The nurse provides the client with literature and discusses which contraceptive with her? medroxyprogesterone acetate etonogestrel norelgestromin/ethinyl estradiol levonorgestrel/ethinyl estradiol

medroxyprogesterone acetate

When using the contraceptive patch, a client should understand that it: should be applied to the breasts, hips, or back. should be covered when swimming in a pool because of chlorine's effect on the adhesive. is immediately effective after application. should be applied to the abdomen, buttocks, or back.

should be applied to the breasts, hips, or back.

A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time? midway between the normal menstrual cycle three days before and three days after ovulation six days before the onset of menstruation five days after the first day of the menstrual cycle

three days before and three days after ovulation