Module 19.A - Family Planning
A female client tells the nurse that she does not want to have children because there is a history of Down syndrome in her family. Which of the following statements should the nurse include in her response to this client? A) "Down syndrome is the most common genetic defect caused by an extra chromosome." B) "Babies born with Down syndrome do not live very long." C) "It is probably best to not give birth to a baby with birth defects." D) "Down syndrome only occurs in the babies of women who are over age 40."
A) "Down syndrome is the most common genetic defect caused by an extra chromosome." Down syndrome is the most common trisomy abnormality seen in children. It is the product of the union of a normal egg or sperm with an egg or sperm that has an extra chromosome. This syndrome can occur at any time in a childbearing client of any age. Although children born with Down syndrome have a variety of physical ailments, advances in medical science have extended their life expectancy. The nurse should not provide an opinion about giving birth to a baby with birth defects.
A client wants to use the vaginal sponge as a method of contraception. Which statements indicate that the client needs further instruction about use of this method? Select all that apply. A) "I should never leave the sponge in for more than 6 hours." B) "I need to use a lubricant prior to insertion of the sponge." C) "I can insert the sponge up to 24 hours before having sex." D) "I need to add spermicidal cream to the sponge prior to having sex." E) "I need to moisten the sponge with water prior to use."
A) "I should never leave the sponge in for more than 6 hours." B) "I need to use a lubricant prior to insertion of the sponge." D) "I need to add spermicidal cream to the sponge prior to having sex." A lubricant is not needed, because the sponge is moistened with water prior to insertion. Spermicidal cream is also unnecessary, because it is already in the sponge. To activate this spermicide, the vaginal sponge must be moistened thoroughly with water. After insertion, the sponge can remain in place for up to 24 hours.
During a health history, the nurse learns that a female client has been trying to conceive for 2 years and does not understand why she cannot become pregnant. Which risk factors for infertility should the nurse assess for in this client? Select all that apply. A) Amount of alcohol consumed each day B) Poor nutrition C) Amount of exercise D) Employment status E) History of sexually transmitted infections
A) Amount of alcohol consumed each day B) Poor nutrition C) Amount of exercise E) History of sexually transmitted infections Risk factors for female infertility include excess alcohol consumption, poor diet, athletic training, or being infected with a sexually transmitted infection. Employment status is not a risk factor for female infertility.
A female client tells the nurse she would like to wait to start a family, even though her partner seems interested in having children in the near future. The client then asks the nurse what she should do. Which response from the nurse is best? A) "Maybe you should babysit a friend's child for a while to see whether you really want children." B) "You and your partner need to discuss the decision to start a family." C) "If you don't want to start a family, then you don't have to." D) "What would you do if you became pregnant now?"
B) "You and your partner need to discuss the decision to start a family." Making the decision to have children is the first step a couple makes in the process of conception. Sometimes one individual wishes to have a child but the other does not. In these situations, open discussion is essential to reach a mutually acceptable decision. Telling the client that she does not need to start a family if she doesn't want to ignores the issue of the partner's desire for children. Asking what the client would do if she became pregnant now does not address the client's desire to wait to start a family. Suggesting the client babysit a friend's child would be a strategy to help a person decide if he or she wants to have a family, but it does not address the client and spouse's current issue.
Why would a healthcare provider most likely recommend that a 37-year-old pregnant woman seek prenatal genetic testing? A) Because women over age 35 are at increased risk for gestational diabetes and other pregnancy complications B) Because babies born to women over age 35 are at increased risk for chromosomal abnormalities C) Because women over age 35 have a higher likelihood of giving birth to twins D) Because women over age 35 are more likely to give birth to male children
B) Because babies born to women over age 35 are at increased risk for chromosomal abnormalities Genetic testing is recommended for women over age 35 because of the increased risk of giving birth to a child with chromosomal abnormalities. Although women over 35 are at increased risk for pregnancy complications, genetic screening does not reduce this risk. Similarly, while women over age 35 are more likely to have twins, the presence of multiple embryos or fetuses can be determined without the need for genetic testing. Finally, the likelihood of having a male or female child does not vary with maternal age.
During an evaluation for infertility, a male client is asked to provide a sperm sample. What information from the client's health history could impact the quality and effectiveness of the client's sperm? Select all that apply. A) Activity level B) Smoking C) Use of over-the-counter analgesics D) Mumps after adolescence E) Number of siblings
B) Smoking C) Use of over-the-counter analgesics D) Mumps after adolescence The quality and effectiveness of sperm is affected by smoking history, use of over-the-counter medications, and experiencing mumps after adolescence. Activity level and number of siblings are not criteria to evaluate the quality and effectiveness of a man's sperm.
A nurse educator is teaching a group of student nurses about problems of infertility and genetic inheritance of disease. Which statement made by a student nurse indicates that teaching has been effective? A) "A person's genotype is the observable expression of his or her traits." B) "The total genetic makeup of an individual is referred to as the phenotype." C) "In an autosomal recessive inherited disorder, the individual must have two abnormal genes to be affected." D) "An individual is said to have an autosomal dominant inherited disorder if the disease trait is homozygous."
C) "In an autosomal recessive inherited disorder, the individual must have two abnormal genes to be affected." In an autosomal recessive inherited disorder, the individual must have two abnormal genes to be affected. A person's phenotype is the observable expression of his or her traits, and the person's genotype is his or her total genetic makeup. An individual is said to have an autosomal dominant inherited disorder if the disease trait is heterozygous—that is, the abnormal gene overshadows the normal gene of the pair to produce the trait.
The nurse is teaching a client with infertility about the medication clomiphene (Clomid). Which statement on the part of the client indicates that this teaching has been effective? A) "This medication increases the amount of gonadotropin-releasing hormone." B) "This medication leads to increased levels of follicle-stimulating hormone." C) "This medication stimulates the secretion of luteinizing hormone." D) "This medication increases my estrogen levels so that I can ovulate."
C) "This medication stimulates the secretion of luteinizing hormone." Clomiphene (Clomid) stimulates the secretion of luteinizing hormone (LH), resulting in the maturation of more ovarian follicles than would normally occur. Clomiphene (Clomid) does not increase estrogen levels, nor does it stimulate secretion of FSH or gonadotropin-releasing hormone.
A nurse is caring for a client who wants more information about fertility awareness-based contraceptive methods. Which statement made by the nurse provides the client with correct information? A) "For women, the fertility window occurs between days 19 and 26 of the menstrual cycle." B) "The calendar rhythm method is based on the assumption that ovulation tends to occur about 7 days before the start of a woman's next menstrual period." C) "To use the calendar rhythm method, a woman must record her menstrual cycles for 6 months to identify the shortest and longest cycles." D) "The calendar method is the most reliable fertility awareness-based method of contraception."
C) "To use the calendar rhythm method, a woman must record her menstrual cycles for 6 months to identify the shortest and longest cycles." Fertility awareness-based methods, also known as natural family planning, are based on an understanding of the changes that occur throughout a woman's ovulatory cycle. For women, the fertility window occurs between days 8 and 19 of 26- to 32-day cycles. The calendar rhythm method, also called the standard days method, is based on the assumption that ovulation tends to occur about 14 days before the start of a woman's next menstrual period. To use this method, the woman must record her menstrual cycles for 6 months to identify the shortest and longest cycles. The calendar method is the least reliable of the fertility awareness methods.
A client is prescribed an oral contraceptive that contains estrogen and progesterone. What information should the nurse include when educating the client about this contraceptive? Select all that apply. A) The estrogen portion of the contraceptive may cause an increase in appetite and subsequent weight gain. B) The progesterone portion of the contraceptive may cause headaches and nausea. C) Breast tenderness may occur when taking oral contraceptives that contain estrogen. D) Taking an oral contraceptive that contains progesterone can lead to an increase in blood pressure. E) Acne and oily skin are common side effects of the progesterone component in combined oral contraceptives.
C) Breast tenderness may occur when taking oral contraceptives that contain estrogen. E) Acne and oily skin are common side effects of the progesterone component in combined oral contraceptives. There are a variety of possible side effects when taking oral contraceptives that contain both estrogen and progesterone. The estrogen component of these contraceptives may cause headaches, nausea, breast tenderness, and an increase in blood pressure. The progesterone portion may cause acne, oily skin, an increase in appetite, and weight gain.
Which of the following statements is true with regard to women's sexual health during the postpartum period? A) The lactational amenorrhea method is the most reliable form of contraception during the postpartum period, but only if a woman is breastfeeding exclusively. B) Condoms and spermicides should not be used for contraception in the immediate postpartum period, because they increase a woman's risk for uterine infection. C) Hormonal contraceptives can affect the quantity and quality of breast milk and increase the risk for deep vein thrombosis (DVT) if used in the first month after giving birth. D) Women who use diaphragms as their primary means of contraception should be refitted for these devices no more than 6 weeks after giving birth.
C) Hormonal contraceptives can affect the quantity and quality of breast milk and increase the risk for deep vein thrombosis (DVT) if used in the first month after giving birth. Clients who are breastfeeding exclusively may choose the lactational amenorrhea method (LAM). However, the effectiveness of LAM varies greatly, so women who use this method should be encouraged to consider a secondary method of contraception. Condoms and spermicides are an excellent and safe option in the immediate postpartum period. Hormonal contraceptives may be inappropriate because they can affect the quantity and quality of breast milk and increase the risk for DVT if used in the first month after giving birth. Diaphragms should not be used until at least 6 weeks postpartum, at which time the woman will need to be refitted for a new device.
A client tells the nurse she plans to use oral contraceptives for birth control. Given this information, which client behavior would cause the nurse the most concern? A) The client has several sexual partners. B) The client is being treated for bipolar disorder. C) The client smokes a pack of cigarettes each day. D) The client drinks two glasses of wine per day.
C) The client smokes a pack of cigarettes each day. Smoking while taking oral contraceptives increases the client's risk of developing a thrombolytic disorder. Drinking two glasses of wine a day is not a contraindication to the use of oral contraceptives, nor is being treated for bipolar disorder. Having several sexual partners does not preclude the use of oral contraceptives, but the client should be advised that oral contraceptives do not provide protection against sexually transmitted infections so use of a barrier method is also recommended.
